We carried out a focused inspection of Church Road Dental Practice on 14 November 2017.

The inspection was led by a CQC inspector who had access to telephone support from a dental clinical adviser.

We carried out the inspection to follow up concerns we originally identified during a comprehensive inspection at this practice on 29 August 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 area(s) 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 Good Governance 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 Church Road Dental Practice on our website www.cqc.org.uk.

We also reviewed some of the key questions of safe and effective as we had made recommendations for the provider relating to these key questions. We noted that improvements had been made.

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 dealt with the regulatory breach we found at our inspection on 29 August 2017.

We carried out this announced inspection on 29 August 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 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 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 not providing well-led care in accordance with the relevant regulations.

Background

Church Road Dental Practice is based in Redfield a suburb of Bristol and provides mainly private treatment to patients of all ages. They have a small NHS contract to see patients on an urgent basis, for orthodontics and children.

There is a temporary ramp that can be used for accessing the ground floor of the practice, particularly for patients who use wheelchairs. There is no practice car parking. The practice is on a main bus route and there is a short stay car park nearby.

The dental team includes three dentists, an orthodontist, four dental nurses, a practice manager who also covers reception and is a qualified dental nurse and three receptionists. The practice manager spends half a day week and four days a week every seventh week carrying out their management role. Due to restrictions in the practice there is no office space for the manager to work within. The practice has three treatment rooms.

The practice is owned by an individual who is the principal dentist. 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 59 CQC comment cards from this inspection and 35 from 2015 where the inspection had been cancelled but comment cards had been completed by patients. This information gave us a positive view of the practice.

During the inspection we spoke with three dentists, a dental nurse, practice manager and a receptionist. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

• Monday to Friday 8:30am to 5:30pm

Our key findings were:

• The practice appeared clean and well maintained.
• The practice had infection control procedures which reflected published guidance. Infection control audits did not always identify areas of the practice that could be improved.

• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available. Monitoring of the equipment could be further improved.

• The practice had systems to help them manage risk. Although these were not effective particularly in relation to fire safety and prescription monitoring.
• The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• The practice had thorough staff recruitment procedures. Although these could be further improved.
• 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 a supportive leadership. 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:

• Ensure an effective system is established to assess, monitor and mitigate the various risks arising from undertaking of the regulated activities. This includes the following; ensuring current legislation and regulations are followed in respect of fire safety. Ensure there is a system in place to monitor effectively the management of prescriptions.

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

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

• Review the protocol for completing accurate, complete and detailed records relating to employment of staff. This includes making appropriate references are sourced and ensuring recruitment checks, including Disclosure and Barring Service checks, are suitably obtained and recorded.
• Review its responsibilities as regards to the 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.
• Review how often the oxygen and automated external defibrillator are checked giving due regard to guidelines issued by the Resuscitation Council (UK), and the General Dental Council (GDC) standards for the dental team.
• Review practice policy on how urgent referrals should be monitored and followed up to establish the patient has received the treatment required.
• Review the practice’s infection control procedures and protocols 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'. Review how audits are carried out to ensure it includes areas of improvement to meet these guidelines.