We carried out a focused inspection of Cheltenham Dental Spa & Implant Clinic on 31 October 2017.

The inspection was led by a CQC inspector who was supported by a specialist dental adviser.

We carried out the inspection to follow up concerns we originally identified during a comprehensive inspection at this practice on 4 April 2017 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions.

At a comprehensive inspection we always ask the following five questions to get to the heart of patients’ experiences of care and treatment:

• Is it safe?
• Is it effective?
• Is it caring?
• Is it responsive to people’s needs?
• Is it well-led?

When one or more of the five questions is not met we require the service to make improvements and send us an action plan. We then inspect again after a reasonable interval, focusing on the areas where improvement was required.

At the previous comprehensive inspection we found the registered provider was providing safe, effective, caring and responsive care in accordance with relevant regulations. We judged the practice was not providing well-led care in accordance with Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can read our report of that inspection by selecting the 'all reports' link for Cheltenham Dental Spa & Implant Clinic on our website www.cqc.org.uk.

Our findings were:

Are services well-led?

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

The provider had made improvements to put right the shortfalls and deal with the regulatory breaches we found at our inspection on 4 April 2017.

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

The provider had made sufficient improvements to put right the shortfalls and had dealt with the regulatory breaches we found at our inspection on 4 April 2017.

We carried out this announced inspection on 4 April 2017 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. 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 and a second CQC inspector who were 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 this practice was providing safe care in accordance with the relevant regulations.

Are services effective?

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

Are services caring?

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

Are services responsive?

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

Are services well-led?

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

Background

Cheltenham Dental Spa and Implant Clinic is in Cheltenham and close to the town centre and provides private treatment to patients of all ages.

The practice is not accessible to patients with disabilities and they have an arrangement with another local dental practice to see patients who cannot access the practice. Car parking is in nearby public car parks. There is a local bus service directly outside the practice.

The dental team includes four dentists, one qualified dental nurse and three trainee dental nurses, one dental hygienist a practice manager and a receptionist. The practice has two 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.

On the day of inspection we collected 11 CQC comment cards filled in by patients and spoke with three other patients. This information gave us a positive view of the practice.

During the inspection we spoke with one dentist, the qualified dental nurse and two trainee dental nurses, the receptionist and the practice manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open: Monday & Thursday 9.00am – 5.00pm; Tuesday 9.00am – 6.00pm; Wednesday & Friday 9.00am - 7.00pm. The practice operates an out-of-hours emergency service available until 9.00pm during weekdays and 9.00am-5.00pm Saturdays and Sundays. Details of the call out fees are on the website.

Our key findings were:

• The practice was clean and well maintained.
• The practice had infection control procedures which mostly reflected published guidance.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• The practice had some systems to help them manage risk but they were not operated effectively.
• The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• The practice staff recruitment procedures were not always thorough and did not fully meet the regulatory requirements.
• The clinical staff provided patients’ care and treatment in line with current guidelines.
• 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 limited leadership with some governance systems but they were not operated effectively.
• 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.
• Several audits to assess and monitor the service had been completed but few actions taken to address shortfalls and no clear action plans.

We identified regulations the provider was not meeting. They must:

• Ensure the proper and safe management of medicines.
• Ensure systems and processes are effectively operated to assess, monitor and improve the quality and safety of services provided.
• Ensure systems and process to manage infection prevention and control follow current legislative guidance including environmental cleaning.
• Ensure staff involved in the provision of conscious sedation have the relevant training, competence and skills to do so safely.
• Ensure risks relating to health and safety and welfare are assessed monitored and mitigated where possible in accordance with current guidance and legislation.
• Ensure records relating to the management of regulated activities are maintained and stored in accordance with record keeping guidance.
• Ensure all required checks are completed in accordance with legislation prior to staff commencing work in the practice.

Full details of the regulations the provider was not meeting are at the end of this report.

When we visited Cheltenham Spa and Implant Clinic we spoke to four patients, the dentist, the practice manager and a dental nurse. We looked at the decontamination room where instruments were sterilised, treatment records and procedures.

The patients told us that the dentist had always asked about their medical history at every visit and explained their treatment to them in detail which had included the costs. We found that information had been given to patients about their treatment. Computerised treatment plans had been recorded that detailed each visit and also alerted clinicians to any health related concerns. We spoke to three patients who told us, "lovely here the care and attention is brilliant, I can't fault it", "I was seen immediately when I was in pain" and "excellent here". There were arrangements in place to protect children and vulnerable adults from the risk of abuse.

There were effective systems in place to reduce the risk of infection and clinical staff knew about the decontamination procedures. The systems in the practice had been regularly audited to help ensure that quality assurance was completed.