We carried out this unannounced inspection on 21 June 2018 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions due to concerns received. We planned the inspection to check whether the registered provider was meeting the legal requirements in the Health and Social Care Act 2008 and associated regulations. The inspection was led by a CQC inspector who was supported by a specialist dental adviser.

To get to the heart of patients’ experiences of care and treatment, we always ask the following five questions:

• Is it safe?

• Is it effective?

• Is it caring?

• Is it responsive to people’s needs?

• Is it well-led?

These questions form the framework for the areas we look at during the inspection.

Our findings were:

Are services safe?

We found that this practice was providing safe care in accordance with the relevant regulations.

Are services effective?

We found that this practice was providing effective care in accordance with the relevant regulations.

Are services caring?

We found that this practice was providing caring services in accordance with the relevant regulations.

Are services responsive?

We found that this practice was providing responsive care in accordance with the relevant regulations.

Are services well-led?

We found that this practice was providing well-led care in accordance with the relevant regulations.

Background

Cestria Dental Practice is in Chester Le Street and provides NHS and private treatment to adults and children.

The practice entrance has a small step in front and a portable ramp is available for people who use wheelchairs and those with pushchairs. Limited car parking spaces are available near the practice; a car park is close by.

The dental team includes the principal dentist, two associate dentists, five dental nurses (two of whom are trainees), a dental hygiene therapist, a practice manager and a receptionist. The practice has three treatment rooms.

The practice is owned by an individual who is the principal dentist there. They have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run.

During the inspection we spoke with two dentists, two dental nurses and the practice manager. We looked at practice policies and procedures and other records about how the service is managed. We also spoke with three patients who provided further information of patient experience using the service.

The practice is open:

Monday, Wednesday and Friday 9am to 5pm

Tuesday 9am to 8pm

Thursday 9am to 6pm

Saturday – by request

Our key findings were:

• The practice appeared clean and well maintained.
• The practice had infection control procedures which reflected published guidance.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• The practice had systems to help them manage risks.
• The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• The practice had staff recruitment procedures. The process for monitoring Disclosure and Barring Service (DBS) checks and immunisation status of staff required reviewing.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• The appointment system met patients’ needs.
• The practice had effective leadership and culture of continuous improvement.
• Staff felt involved and supported and worked well as a team.
• The practice asked staff and patients for feedback about the services they provided.
• The practice dealt with complaints positively and efficiently.
• The practice had suitable information governance arrangements.
• The practice was providing preventive care and supporting patients to ensure better oral health in line with current guidelines.

There were areas where the provider could make improvements. They should:

• Review the practice's recruitment policy and procedures to ensure accurate, complete and detailed records are maintained for all staff.
• Review the practice's policy for hazardous substances identified by the Control of Substances Hazardous to Health Regulations 2002, to ensure risk assessments are undertaken.

We carried out a follow up inspection at Cestria Dental Practice on the 16 March 2017.

We had undertaken an unannounced comprehensive inspection of this service on the 26 January 2017 as part of our regulatory functions where breaches of legal requirements were found.

After the comprehensive inspection, the practice wrote to us to say what they would do to meet the legal requirements in relation to each of the breaches. This report only covers our findings in relation to those requirements.

We reviewed the practice against two of the five questions we ask about services: is the service safe and well led?

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Cestria Dental Practice on our website at www.cqc.org.uk.

We revisited the Cestria Dental Practice as part of this review and checked whether they had followed their action plan and to confirm they now met the legal requirements.

Our findings were:

Are services safe?

We found that this practice was providing safe care in accordance with the relevant regulations.

Are services well-led?

We found that this practice was providing well-led care in accordance with the relevant regulations.

Background

Cestria Dental Practice is located in Chester-Le-Street and provides NHS and private treatment to adults and children.

Wheelchair users or people with pushchairs can access the practice through a portable ramp at the front of the practice. Car parking spaces are available near the practice.

The dental team is comprised of two dentists, four dental nurses, a dental hygiene therapist, a receptionist and a business manager.

The practice has three surgeries, two on first floor and one on the ground floor, a dedicated room for taking Orthopantomogram (OPG) X-rays, a decontamination room for sterilising dental instruments, a staff room/kitchen and a general office.

On the day of inspection we received 23 CQC comment cards providing feedback. The patients who provided feedback were positive about the care and attention to treatment they received at the practice. They told us they were involved in all aspects of their care and found the staff to be very pleasant and helpful; staff were friendly and communicated well. Patients commented they could access emergency care easily and they were treated with dignity and respect in a clean and tidy environment.

The practice is open:

Monday – Friday 9am – 5pm.

The principal dentist is registered with the Care Quality Commission (CQC) as an individual registered person. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the practice is run.

Our keys findings were:

• The practice required further improvement with regards to the infection control validation of equipment process and must ensure staff are suitably trained to undertake the task.
• The practice had reviewed and implemented a new medical emergency drug bag and a new medical oxygen cylinder.
• A new Legionella risk assessment had been completed.
• COSHH products were stored securely and the risk assessments were in the process of being implemented.
• A sharps risk assessment and policy had been introduced.
• A protocol for the safe management of medicines and use of prescriptions was now in place; only the dentists could dispense prescription only medicines.
• All staff had now completed training for safeguarding adults and children. A new folder had been put in place for reference.
• Learning and development needs were monitored by the business manager.
• Actions from the fire risk assessment had been costed and a date had been booked to complete the work.
• All recruitment procedures had been reviewed to bring in line with the practice policy.
• The X-ray audit had been completed and the Infection prevention audit was underway.
• The practice had registered for patient safety alerts, recalls and rapid response reports issued from the Medicines and Healthcare products Regulatory Agency (MHRA).

There were areas where the provider could make improvements and should:

• Review the practice’s infection control procedures and protocols are suitable giving due regard to guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices and The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance’.

We carried out an unannounced responsive inspection on 26 January 2017 to ask the practice the following key questions; Are services safe, effective, caring, responsive and well-led?

Our findings were:

Are services safe?

We found that this practice was not providing safe care in accordance with the relevant regulations.

Are services effective?

We found that this practice was providing effective care in accordance with the relevant regulations.

Are services caring?

We found that this practice was providing caring services in accordance with the relevant regulations.

Are services responsive?

We found that this practice was providing responsive care in accordance with the relevant regulations.

Are services well-led?

We found that this practice was not providing well-led care in accordance with the relevant regulations.

Background

Cestria Dental Practice is located in Chester Le Street and provides NHS and private treatment to adults and children.

Wheelchair users or pushchairs can access the practice through a portable ramp at the front of the practice. Car parking spaces are available near the practice.

The dental team is comprised of two dentists, four dental nurses, a dental hygiene therapist, a receptionist and a business manager.

The practice has three surgeries two on first floor and one on the ground floor, a dedicated room for taking Orthopantomogram (OPG) X-rays, a decontamination room for sterilising dental instruments, a staff room/kitchen and a general office.

On the day of inspection we received 23 CQC comment cards providing feedback. The patients who provided feedback were positive about the care and attention to treatment they received at the practice. They told us they were involved in all aspects of their care and found the staff to be very pleasant and helpful; staff were friendly and communicated well. Patients commented they could access emergency care easily and they were treated with dignity and respect in a clean and tidy environment.

The practice is open:

Monday – Friday 9am – 5pm.

The principal dentist is registered with the Care Quality Commission (CQC) as an individual registered person. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the practice is run.

Our key findings were:

• The practice appeared clean and well maintained.
• Infection control procedures did not follow published guidance in relation to the validation of equipment.
• Staff had been trained to handle emergencies. The provider did not have in date emergency medicines in line with the British National Formulary (BNF) guidance for medical emergencies in dental practice.
• The practice did not have systems in place manage risks.
• Staff understood safeguarding and knew how to recognise signs of abuse. Evidence of training was inconsistent and polices did not include details of local services.
• Treatment was well planned and provided in line with current guidelines.
• The service was aware of the needs of the local population and took these into account in how the practice was run.
• The practice sought feedback from staff and patients about the services they provided.
• Complaints were responded to in an efficient and responsive manor.
• Governance arrangements were in not place for the smooth running of the practice; the practice did not have a structured plan in place to continuously audit quality and safety including infection prevention and control and radiographs.

We identified regulations that were not being met and the provider must:

• Ensure the practice’s infection control procedures and protocols are suitable giving due regard to guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices and The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance’.
• Ensure the practice has availability of medicines and equipment to manage medical emergencies giving due regard to guidelines issued by the British National Formulary, the Resuscitation Council (UK), and the General Dental Council (GDC) standards for the dental team.
• Ensure the practice undertakes a Legionella risk assessment and implements the required actions giving due regard to guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices and The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance’
• Ensure the practice knows about their responsibilities in regards to Control of Substance Hazardous to Health (COSHH) Regulations 2002 and ensure all documentation is up to date and staff understand how to minimise risks associated with the use of and handling of these substances.
• Ensure the practice’s sharps handling procedures and protocols are in compliance with the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.
• Ensure systems are put in place for the safe management of medicines, ensure the security of prescription pads in the practice and ensure there are systems in place to monitor and track their use.
• Ensure protocols are implemented regarding the prescribing and recording of prescription only medicines.
• Ensure that all staff undergo relevant training, to an appropriate level, in the safeguarding of children and vulnerable adults and policies and protocol are available with local safeguarding information.
• Ensure the training, learning and development needs of staff members are reviewed at appropriate intervals and an effective process is established for the on-going assessment and supervision of all staff employed.
• Ensure an effective system is established to assess, monitor and mitigate the various risks arising from undertaking of the regulated activities including implementing the actions from the fire risk assessment.
• Ensure the practice's recruitment policy and procedures are suitable and the recruitment arrangements are in line with Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 to ensure necessary employment checks are in place for all staff and the required specified information in respect of persons employed by the practice is held. Ensure induction training and awareness of practice policies is implemented.
• Ensure the practice implements audit protocols of various aspects of the service, such as radiography and infection prevention and control at regular intervals to help improve the quality of service. The practice should also check all audits have documented learning points and the resulting improvements can be demonstrated.

You can see full details of the regulations not being met at the end of this report.

There were areas where the provider could make improvements and should:

• Review the practice’s protocols for the use of rubber dam for root canal treatment giving due regard to guidelines issued by the British Endodontic Society.
• Review the storage of dental care records to ensure they are stored securely.
• Review the practice’s arrangements for receiving and responding to patient safety alerts, recalls and rapid response reports issued from the Medicines and Healthcare products Regulatory Agency (MHRA) and through the Central Alerting System (CAS), as well as from other relevant bodies such as, Public Health England (PHE).