We carried out a focused inspection of Chipping Manor Dental Practice - Cirencester on 20 March 2018.

We carried out the inspection to follow up concerns we originally identified during a comprehensive inspection at this practice on 16 October 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 Chipping Manor Dental Practice - Cirencester 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 breach we found at our inspection on 16 October 2017.

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 had dealt with the regulatory breach we found at our inspection on 16 October 2017.

We carried out this announced inspection on 16 October 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 who was supported by a specialist dental adviser.

We told the NHS England area team and Healthwatch that we were inspecting the practice. They did not provide any information.

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

Chipping Manor Dental Practice - Cirencester is near the centre of the town and provides NHS and private treatment to patients of all ages.

There is level access for patients who use wheelchairs and pushchairs. Car parking spaces can be found on roads near the practice or in the nearby public car parks.

The dental team includes four dentists, two trained dental nurses and six trainee dental nurses, one dental hygienist, and two receptionists. The practice has five treatment rooms.

The practice is owned by a company and as a condition of registration must have a person registered with the Care Quality Commission as the registered manager. Registered managers have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run. At the time of the inspection the practice did not have a registered manager in post.

On the day of inspection we collected 38 CQC comment cards filled in by patients and spoke with two other patients. This information gave us a positive view of the practice.

During the inspection we spoke with two dentists, one dental nurse, three trainee dental nurses 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, Wednesday, Thursday, Friday 08.00am – 5.30pm.
• Tuesdays 08.00am -8.30pm

·It is closed at weekends and out of hours information is available on the website.

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 risk and they were mostly operated effectively. Systems for ensuring the correct tooth is treated required review and implementation.
• The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• The practice recruitment procedures met the legislative requirements for the safe recruitment of staff.
• 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 mostly effective leadership but it did not ensure staff completed all required continuing professional development through appraisal.
• 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.

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

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out the duties.

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

This inspection was to follow up problems with infection control that we identified at our previous inspection in June 2014.

During this inspection we talked to the practice manager and a dental nurse. We looked at the surgeries and equipment and we checked records.

We found that the problems with infection control had been addressed by equipping a new room for decontamination of instruments. The new decontamination room was arranged so that there was a work flow from dirty to clean instruments. There were two sinks, one for washing and one for rinsing the instruments. We observed the decontamination process and saw that this was on the whole in line with good practice guidance. Issues about hand washing had been addressed. There was a ‘dirty’ hand-washing sink for washing before and after handling dirty instruments. There was also a ‘clean’ hand-washing sink for washing before and after handling clean instruments.

Problems with hygiene in the surgeries had also been addressed. There were cleaning schedules for the cleaner to show which tasks needed to be completed and how often. The practice manager was checking that cleaning had been completed. Wipe clean chairs had been obtained for use of people accompanying patients into the surgeries. Problems with a portable fan and peeling paintwork had been addressed by moving the decontamination room. The sharps box had been securely fixed to the wall so that it did not pose a hazard to people. The edging on the work surfaces in two surgeries had been replaced to make them easier to clean.

We spoke with five patients, two dentists, four dental support staff and the practice manager.

Patients were satisfied with the service. One patient said "everyone is helpful. They explain what they are going to do." Another patient said "it's friendly, I feel quite relaxed."

Patients said they were involved in their treatment plans and their permission was always sought before any treatment commenced. We saw patients had a treatment plan which they signed as consent to the treatment and costs.

Staff followed guidance from the Mental Capacity Act (2005) to support patients with impaired mental capacity. The provider had detailed, comprehensive information about the consent process as guidance for staff.

Staff we spoke with were aware of the legal requirements of consent with regards to treatment for children.

We saw from patients' records appropriate referrals for treatment were made to other healthcare professionals. The provider monitored the referrals to ensure appointments were made promptly.

The provider had effective staff recruitment and selection processes.

The provider had a system which ensured patients' views on the service were listened to.

Patients told us they were satisfied with the cleanliness of the practice. However, we found aspects of the premises were not effectively cleaned. Some infection control procedures did not follow national guidance and put patients at risk of cross infection.

People we spoke to told us that they were happy with the services they recieved, one person said "my children and I are well looked after when we come here, the staff are professional, polite and caring in their approach", another person told us "I am extremley satisifed with the service I recieve, I would never go anywhere else".

People could be assured that robust infection control measures were in place. The provider haa sound sysyems in place to monitor the effectiveness and quality of the service they delievered.

We spoke with members of staff. They told us they had all received training in infection control, resuscitation and first aid. They had also undertaken child protection and adult protection training.

We asked staff about the support they received to do their job. They told us the practice manager was, "very approachable". They also said they received regular job chats, an annual appraisal of their performance and had regular staff meetings. Staff said they could always go to their manager if they needed to discuss anything. They said they all worked, "as a team". They said they always worked as far as possible with the same dentist and this was good because of consistency for them as professionals and for patients, One member of staff said, "we get to know our patients which helps make them feel comfortable coming to the dentist".