We undertook a follow up focused inspection of Dalton Dental Care on 16 November 2018. 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 focused inspection of Dalton Dental Care on 17 May 2018 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 effective and well led care and was in breach of regulation 9, 17 and 18 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 on our website www.cqc.org.uk.

As part of this inspection we asked:

• 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 are not met we require the service to make improvements and send us an action plan (requirement notice only). We then inspect again after a reasonable interval, focusing on the area(s) where improvement was required. The focused inspection carried out on 17 May 2018 did not cover the caring and responsive elements of our inspection process; we covered these areas during the focused follow up inspection on 16 November 2018.

Our findings were:

Are services effective?

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

The provider had made improvements in relation to the regulatory breaches we found at our inspection on 17 May 2018.

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 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 17 May 2018.

Background

Dalton Dental Care is in Rotherham and is part of the Nationwide Healthcare Limited group. Dalton Dental Care provides NHS and private treatment to adults and children.

There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces are available near the practice.

The dental team includes two dentists, a lead dental nurse, two trainee dental nurses, two receptionists and a practice manager. The practice has three treatment rooms and an instrument decontamination room. On the inspection day the regional clinical quality care manager joined the team to assist with the inspection.

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 was one of the Directors.

On the day of inspection we collected 21 CQC comment cards filled in by patients.

During the inspection we spoke with one dentist, the lead dental nurse, the receptionist, the practice manager and the clinical quality care manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday – Friday 9am – 6pm

Our key findings were:

• The provider 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 to patients and staff.
• The provider had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
• Staff were supported with training, professional development, supervision and appraisals.
• The clinical staff provided patients’ care and treatment in line with current guidelines and provided preventive care and supported patients to ensure better oral health.
• Clinical waste processes were in line with recommended guidance.
• The provider had effective leadership and culture of continuous improvement.
• Staff felt involved and supported and worked well as a team.

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

• Review the size of the medical oxygen cylinder to ensure it has the capacity to allow adequate flow rates, eg, 15 litres per minute, until the arrival of an ambulance or the patient fully recovers.

We carried out this announced focussed inspection on 17 May 2018 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 asked the following three questions:

• Is it safe?

• Is it effective?

• 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 not providing effective 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 is in Rotherham and is part of the Nationwide Healthcare Limited group. Dalton Dental Care provides NHS and private treatment to adults and children.

There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces are available near the practice.

The dental team includes two dentists, three trainee dental nurses and two receptionists. The practice has three treatment rooms and an instrument decontamination room. On the inspection day the regional clinical quality care manager and regional practice manager (area management team) joined the team to assist with the inspection.

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 was one of the Directors.

On the day of inspection we collected 16 CQC comment cards filled in by patients.

During the inspection we spoke with one dentist, two dental nurses, a receptionist and both regional managers. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday – Friday 9am – 6pm

Our key findings were:

• The practice appeared clean and maintained.
• The practice had infection control procedures which mostly reflected published guidance; staff awareness of procedures and why they were carried out was not effective and could be improved.
• Staff knew how to respond to a medical emergency. Not all appropriate medical emergency equipment was available.
• The practice had systems to help them manage risk but improvement was needed.
• The practice staff had suitable safeguarding processes in place. Improvements could be made to enhance staff awareness of responsibilities for safeguarding adults and children.
• Recruitment procedures reflected relevant legislation.
• The clinical staff provided patients’ care and treatment mostly in line with current guidelines.
• Clinical awareness of the National Institute for Clinical Excellence (NICE), The Faculty of GeneralDental Practice UK (FGDP (UK) and British Society of Periodontology (BSP) guidance could be improved.
• The disposal of certain types of clinical waste was not carried out in line with recommended guidance.
• The practice was providing preventive care and supporting patients to ensure better oral health but this could be improved.
• The practice did not have effective leadership. Support, training, professional development, supervision and appraisal for junior staff could be improved
• The practice had a system in place to manage complaints effectively

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

• Ensure the care and treatment of patients is appropriate, meets their needs and reflects their preferences.
• 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.

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

• Review the practice's policy for the control and storage of substances hazardous to health identified by the Control of Substances Hazardous to Health Regulations 2002, to ensure risk assessments are undertaken.

People who used the service told us they received the treatment they wanted in an efficient and organised way. One person told us, “It’s all been absolutely fantastic.” People said they were involved in decision making about their treatment and felt able to express their views about the service provided.

People said they always found the premises to be clean and tidy. One person commented, “It’s very clean, I see them wiping down the surfaces et cetera.” Two other people told us the reception and waiting area was more comfortable and cleaner than it use to be. People said staff wore the right protective equipment when treating them, such as uniforms, gloves and masks.

The people we spoke with told us staff were competent in their work, friendly and helpful. They said they had no complaints about the practice but said they knew how to raise concerns if they needed to. When we asked people if there was any way the practice could be improved no-one could think of anything they wanted to change.