We carried out an announced comprehensive inspection of this practice on 3 November 2016. Breaches of legal requirements were found. After the comprehensive inspection, the practice wrote to us to say what they would do to meet legal requirements in relation to breaches in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Part 3) Regulation 17: Good governance. We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to that requirement. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Collingham Dental Practice on our website at www.cqc.org.uk.

We carried out an announced follow up inspection on 13 July 2017 to ask the practice the following key question; Are services well-led?

Our findings were:

Are services well-led?

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

Background

Collingham Dental Practice is a dental practice providing both NHS and private dental treatment for adults and children. The practice is located in premises close to the centre of the village of Collingham in north Nottinghamshire. There is car parking available to the front of the premises. The practice has four treatment rooms, all four of which are on the first floor, and which are accessed either by a flight of stairs or by a passenger lift.

Services provided include general dentistry, dental hygiene, crowns and bridges, and root canal treatment.

The practice is open from 9 am to 6.30pm on Monday and Wednesdays, 9 am to 5 pm on Tuesdays and Thursdays and 9 am to 2 pm on Fridays. The practice closes from Monday to Thursday for lunch from 1pm to 2 pm.

The practice owner is the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. 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.

The practice has two dentists who are able to provide general dental services including endodontic (root canal) treatment. They are supported by a dental nurse, a trainee dental nurse, two part time dental hygienists and a practice manager/receptionist.

Our key findings were:

• The practice had reviewed its system for receiving national patient safety and medicines alerts from the Medicines and Healthcare Products Regulatory Authority (MHRA).
• The practice had reviewed its staff recruitment procedures to ensure they were compliant with the regulations. The necessary documentation to demonstrate compliance was available for inspection.
• The practice had reviewed its risk assessment for Legionella. In addition some staff members had completed training in the risks related to Legionella to gain a better understanding of Legionella risk management.
• All dentists involved in taking X-rays were up-to-date with their radiography training.
• The practice had reviewed its systems related to fire safety. This included an updated fire risk assessment, additional staff training and records to demonstrate the necessary checks had been completed in relation to fire safety.

We carried out an announced comprehensive inspection on 3 November 2016 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 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

Collingham Dental Practice is a dental practice providing both NHS and private care for adults and children. Where private treatment is provided some is provided under a fee per item basis and some under a dental insurance plan. The practice is situated in a purpose built property with all facilities on the first floor but with the benefit of lift access from the ground floor.

The practice has four dental treatment rooms, There is a separate decontamination area where cleaning, sterilising and packing dental instruments takes place. There is also a reception and waiting area and other rooms used by the practice for office facilities and storage. The practice is open from 9.00am to 6.30pm on Monday and Wednesdays, 9.00am to 5.00pm on Tuesdays and Thursdays and 9am to 2pm on Fridays. The practice closes from Monday to Thursday for lunch from1.00pm to 2.00pm.

The practice has two dentists who are able to provide general dental services including endodontic (root canal) treatment. They are supported by a dental nurse, a trainee dental nurse, two part time dental hygienists and a practice manager/receptionist.

The practice owner is the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. 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.

Before the inspection we sent Care Quality Commission comment cards to the practice for patients to complete to tell us about their experience. We also spoke with patients on the day of our inspection. We received feedback from 37 patients. These provided a very positive view of the services the practice provides. Patients commented on the quality of care, the polite and friendly nature of staff and the cleanliness of the practice.

Our key findings were:

• The practice had good facilities and was well equipped to treat patients and meet their needs.
• Routine dental appointments were readily available, as were urgent on the day appointments and patients told us it was easy to get an appointment with the practice.

• The practice was visibly clean and well maintained.

• Patients commented that they were highly satisfied with the care they received and commented on the helpfulness of the staff. They told us treatment options were explained to them and they were involved in decisions about their treatment.
• The practice had a system to identify, investigate and learn from significant events.

• The practice had available medicines and equipment for use in a medical emergency which were in accordance with national guidelines.
• There was a system to manage safety alerts but this was not always effective.

• Appropriate training was available to staff and they were supported in their continued professional development (CPD).
• Risks had been assessed but not all control measures or identified actions had been implemented.

• National guidance was not always followed as we found that information relating to X-rays was not consistently recorded in patient notes and NHS patients did not receive a copy of their treatment plans.

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

Ensure systems and processes are operated effectively to assess and monitor the service and risks in accordance with the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. For example, this includes the management of patient safety alerts; the management of substances hazardous to health and environmental cleaning; taking action to mitigate identified risks and ensuring dental care records are maintained appropriately giving due regard to guidance provided by the Faculty of General Dental Practice regarding X-rays.

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

• Review the practice's recruitment policy, procedures and the recruitment arrangements to ensure they are in line with Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014
• Review the security of prescription pads in the practice and ensure there are systems to monitor and track their use with reference to the NHS guidance on security of prescription forms August 2013.

We used a number of different methods to help us reach a judgement on this service. These including talking with patients using the service, members of the staff team, observation and looking at records.

We spoke with three patients, two dentists, three members of staff and the practice manager. We also looked at records. These included care plans, records of meetings and information about how the service operated. We looked at information from surveys undertaken by the provider to assess the quality of service.

Patients we spoke with said they were fully involved in their care and treatment options, felt it was delivered in a safe way and that the practice was clean and hygienic.

One patient told us, “The staff tell me the costs of treatment and I make a decision based on the information provided.” Another said, “The dentist provides an explanation of what they are doing.”

We observed members of staff interacting with patients in courteous, polite and efficient manner.

We saw that the practice had implemented a clear infection control policy and that staff were encouraged to develop their skills and undertake appropriate training to help deliver safe and effective care to patients.