We carried out an announced comprehensive inspection of this practice on 14 March 2016. A breach of legal requirement was found. After the comprehensive inspection, the practice wrote to us to say what they would do to meet legal requirements in relation to Regulation 17 HSCA (RA) Regulations 2014 Good Governance.

We carried out a desk based review for Danbury Dental Care Ltd on 29 June 2017. This was to follow up on actions we asked the provider to take after our announced comprehensive inspection. During the inspection on March 2016, we identified that the provider must improve safety checks and training for staff with regard to safeguarding training and risk assessments for fire safety and the need for a defibrillator. In addition we identified that the provider must ensure a system was in place ensure regular audits are undertaken in line with recommended guidance with regards to infection control and radiography.

We reviewed the action plan supplied by the practice following the inspection in March 2016. Additional evidence of the improvements made were sent by the practice for us to review. We looked at practice policies and procedures and other records about how the service is managed.

Our findings were:

Are services well-led?

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

Background

Danbury Dental Care is a private dental practice located on the main road in the village of Danbury in Essex. The practice is located on the ground floor of a Grade II Listed building which has been adapted to meet the needs of patients. The practice has approximately 3000 patients and has an olderr than average population.

There are two dentists, a hygienist and three dental nurses, one of whom is also the practice manager.

The practice is open from 8.30am to 8pm on Mondays and from 8.30am to 5pm Tuesday to

Friday. When the practice is closed an answerphone message gives an emergency contact telephone number for one of the dentists who provide out of hours care and advice.

The principal dentist 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.

Our key findings were:

• Improvements were seen in all areas where concerns had been highlighted in the comprehensive inspection.
• Clinical audits were used effectively to highlight areas where improvements could be made.
• Risk assessments were undertaken to assess, monitor, manage and mitigate risks to the health and safety of service users.

• Staff had undergone safeguarding training.

At our announced inspection on 14 March 2016, there were areas we identified where the provider could make improvements. During our desk based review on 29 March 2017 improvements were seen in all areas where the provider could make improvements.

• The practice had introduced a policy for recording and discussing significant events. We examined information the practice sent us and saw that significant events had been reported and discussed at practice meetings to reduce risk and support future learning. For example following the loss of some electronic information the practice had raised a significant event and following discussion had employed the services of a specialist computer organisation to review and monitor their systems. As a result the practice had put systems in place to review and improve the daily back up of computers to avoid further loss and disruption of their systems.
• The practice had reviewed its recruitment procedures to ensure a practice specific recruitment policy was in place.
• The practice had reviewed its protocol for the use of rubber dams in root canal treatment. We were told the dentists now used rubber dams in line with guidance from the British Endodontic Society when providing all root canal treatment.

The provider told us the practice had reviewed its policy on emergency medicines to ensure it complied with nationally recognised guidance.

We carried out an announced comprehensive inspection on 14 March 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

Danbury Dental Care is a private dentist located on the main road in the village of Danbury in Essex. The practice is located on the ground floor of a Grade II Listed building which has been adapted to meet the needs of patients. The practice has approximately 3000 patients and has an older than average population. There are two dentists, a hygienist and three dental nurses, one of whom is also the practice manager. The practice is open from 8.30am to 8pm on Mondays and from 8.30am to 5pm Tuesday to Friday. When the practice is closed an answerphone message gives an emergency contact telephone number for one of the dentists who provide out of hours care and advice.

The principal dentist 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.

We received feedback from 41 patients via CQC comment cards, this feedback was very positive about the care and treatment received from all staff within the practice.

Our key findings were:

• The practice did not have a system for recording and analysing significant events.
• The practice had identified and managed risks to patients, however not all findings within the fire risk assessment had been acted on.
• The practice did not have a recruitment policy in place; staff had the relevant checks carried out. Staff underwent a thorough induction process.
• The practice had emergency oxygen and emergency medicines available and all staff knew of their location. The practice did not have a defibrillator available and there was no risk assessment in place to address this issue. Staff had received some basic safeguarding training and knew the procedures to follow to raise any concerns. This training was not to the standard expected of dental professionals.
• Infection control procedures were in place, there was a policy available but there was not a lead member of staff and there were no infection control audits carried out.
• Rubber dams were not being used in the treatment of root canal.
• Radiography audits were not being carried out.
• The practice had a complaints policy in place. Complaints were acknowledged and dealt with in a timely manner.
• All staff had evidence of attending basic life support training.
• There were sufficient numbers of suitably qualified staff to meet patients’ needs
• Patients’ care and treatment was planned and delivered in line with evidence based guidelines, best practice and current legislation.
• Patients received clear and detailed explanations about their proposed treatment, its costs, options and risks. Patients were therefore able to make informed decisions about their choice in treatments.
• We observed that patients were treated with dignity and respect and confidentiality was maintained.
• The appointment system met patients’ needs whether they wanted to be seen urgently or for routine appointments.
• Staff meetings were held monthly, these meetings were recorded and staff signed to confirm their attendance.

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

• Ensure all risks to patient’s safety are well managed by addressing the findings within the fire risk assessment and conducting a risk assessment for the need of a defibrillator.
• Ensure infection control audits are carried out in line with recommended guidance.
• Ensure staff receive the level of safeguarding training that is recommended for dental professionals.
• Ensure radiography audits are carried out to govern the safe, appropriate and effective use of x-rays.

You can see full details of the regulations not being met at the end of this report.

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

• Review medicines to be used in the case of emergency to ensure it complies with nationally recognised guidance.

• Review the system for identifying, recording, analysing and sharing significant events.
• Review the practice’s protocols for the use of rubber dam for root canal treatment giving due regard to guidelines issued by the British Endodontic Society

Introduce a practice specific recruitment policy.

All the people we spoke with were very complimentary about the service and treatment they had received at Danbury Dental Care and would recommend the practice to family and friends.

One person told us "I just love the relaxed friendly atmosphere, pain free injections and treatment.” Another person said “I have faith in my dentist, based on ten years of experience with him."

All the people we spoke with said that the staff were very helpful and friendly. Some comments included. "The atmosphere is always friendly” and “Everyone always tries to help you out if you are having difficulties.” One person said “I have never had any problems with re-arranging my appointments if I need to.”

All the people we spoke with told us that they were always provided with information about their treatment in a way that they could understand and that it had included options, risks and costs. They all felt they had been very involved in their treatment.