We undertook a follow up focused inspection of Dalton Dental Care Limited on 29 April 2019. This inspection was carried out to review in detail the actions taken by the registered provider to improve the quality of care and to confirm that the practice was now meeting legal requirements.

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

We undertook a comprehensive inspection of Dalton Dental Care Limited on 21 January 2019 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We found the registered provider was not providing well led care and was in breach of 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 Dalton Dental Care Limited on our website www.cqc.org.uk.

As part of this inspection we asked:

• Is it well-led?

When one or more of the five questions are 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.

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 in relation to the regulatory breach we found at our inspection on 21 January 2019.

Background

Dalton Dental Care Limited is in Huddersfield and provides NHS and private treatment to adults and children.

Due to the nature of the premises access for wheelchair users is not possible. Wheelchair users or those who cannot manage steps would be signposted to either the local community dental service or an accessible local dental practice. Car parking spaces are available near the practice.

The dental team includes four dentists and six dental nurses (one of whom also works as the practice manager). The practice has three 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. The registered manager at Dalton Dental Care Limited is the principal dentist.

During the inspection we spoke with the practice manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday to Friday from 9:00am to 5:30pm

Our key findings were:

• Improvements had been made to the process for ensuring medical emergency equipment reflects nationally recognised guidance.
• Improvements had been made to the systems and processes for managing the risks associated with fire, Legionella and the use of radiation.
• Improvements had been made to the recruitment process.

We carried out this announced inspection on 21 January 2019 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.

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

Dalton Dental Care Limited is in Huddersfield and provides NHS and private treatment to adults and children.

Due to the nature of the premises access for wheelchair users is not possible. Wheelchair users or those who cannot manage steps would be signposted to either the local community dental service or an accessible local dental practice. Car parking spaces are available near the practice.

The dental team includes four dentists, six dental nurses and a practice manager. The practice has three 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. The registered manager at Dalton Dental Care Limited is the principal dentist.

On the day of inspection, we collected 25 CQC comment cards filled in by patients.

During the inspection we spoke with three dentists, one dental nurse 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 to Friday from 9:00am to 5:30pm

Our key findings were:

• The practice appeared clean and well maintained.
• The provider had infection control procedures which reflected published guidance. The storage of some re-usable dental instruments could be improved.
• Staff knew how to deal with emergencies. Not all medical emergency equipment was available and one of the medical emergency medicines was not the correct dosage.
• Actions recommended in the Legionella risk assessment had not all been actioned.
• Improvements could be made to the process for checking fire detection and firefighting equipment,
• The provider had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
• The provider had staff recruitment policy. There was no evidence of photographic identification for any 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.
• Staff were providing preventive care and supporting patients to ensure better oral health.
• The appointment system took account of patients’ needs.
• Staff felt involved and supported and worked well as a team.
• The provider asked staff and patients for feedback about the services they provided.
• The provider had suitable information governance arrangements.

We identified regulations the provider was not complying with. They must:

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

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

During our inspection of this service we were able to talk with five people who used the service who told us that they were satisfied with the service provided.

The patient satisfaction survey carried out in July 2012 showed that 95% of patients were satisfied with the overall experience of visiting the dental practice.

People told us they were happy with the staff at the practice. People’s comments about staff included:

"The Dentist is absolutely lovely I'm nervous and it goes a long way to reassure you"

"The staff are very nice and approachable"

"The staff are brilliant and are very helpful"

We found that the service followed best practice in gaining people's consent to treatment, providing choices, delivery of treatment and hygiene standards. Staff told us that received good training and enjoyed working at the practice.