We carried out a focused inspection of Danesholme Dental Practice on 27 September 2017.

The inspection was led by a CQC inspector who was supported by a second CQC inspector.

We carried out the inspection to follow up concerns we originally identified during a comprehensive inspection at this practice on 18 October 2016 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 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 Danesholme Dental Practice on our website www.cqc.org.uk.

We also reviewed the key questions of safe and responsive 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 deal with the regulatory breach we found at our inspection on 18 October 2016.

We carried out an announced comprehensive inspection on 18 October 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

Danesholme dental practice is a general dental practice situated in a residential area of Corby, Northamptonshire. The practice is situated on ground floor premises which allows for wheelchair access via a ramp to assist with the front step.

The practice staff consists of the principal dentist, dental nurse and receptionist, and they offer general dental treatment to adults and children funded privately. The practice carries out occasional domiciliary visits to patients in their own homes.

The practice is open from 9 am to 5.30 pm on Monday, Tuesday, Thursday and Friday, and is open for enquiries only on a Wednesday from 9 am to 1 pm.

The practice has a reception and waiting area, a treatment room, an X-ray room and a dedicated decontamination room.

The principal dentist is registered with the Care Quality Commission (CQC) as an individual. 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 patients by way of comment cards which were available at the practice for two weeks prior to our visit. 31 patients provided feedback in this way and their comments were overwhelmingly positive about the service they received.

Our key findings were:

• The practice was visibly clean and mostly clutter free.

• Patients reported that the practice staff were always professional and caring and that time was taken to ensure that treatment options were explained to them in detail.

• Infection control standards met national guidance.

• A new patient appointment could normally be secured within a week of contacting the practice and in an emergency the practice would endeavour to see patients on the day they contacted it.

• The practice had emergency medicines and equipment in line with national guidelines.

• The practice had not taken adequate steps to assess the risks within the practice.

• The practice had not met the recommendations of the Legionella risk assessment which had been completed in January 2016. Although the practice were addressing this at the time of the inspection.

• The practice did not have appropriate systems in place to identify the servicing and testing requirements of certain equipment.

• The practice had appropriate systems in place to ensure the practice employed fit and proper persons.

• The practice had not taken steps to ensure they remained informed of any alerts or recalls relevant to the service.

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

• Ensure effective systems are established to assess, monitor and mitigate the service against the Health and Social Care Act 2008 (Regulated Activities) 2014. For example, this includes the management of significant events, implementing and responding to risk assessments, ensuring policies within the practice are reviewed and updated and systems to ensure equipment is appropriately serviced and tested are effective.

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 the practice’s arrangements for receiving and responding to patient safety alerts, recalls and rapid response reports issued from the Medicines and Healthcare products Regulatory Agency (MHRA) and through the Central Alerting System (CAS), as well as from other relevant bodies such as, Public Health England (PHE).

• 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.

• Review the use of rectangular collimators on X-ray machines to further reduce the radiation dose to patients.

• Review the availability of an interpreter service for patients who do not speak English as their first language.

• Review the current legionella risk assessment and implement the required actions giving due regard to the 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.

At a previous inspection on 06 December 2013, we asked the provider to make improvements so appropriate checks were in place to ensure the procedure of conscious intravenous sedation for nervous people was carried out safety. We also asked the provider to make improvements to their infection control procedures so patients and staff that used the service were protected from the risk of infection.

During this inspection we found that the required changes had been made. The provider had introduced an audit of the procedure of conscious intravenous sedation and ensured they worked to the recommended clinical standards. There was an infection control policy and the provider had audited their infection control practices against a document called HTM 01-05 which are the standards related to effective infection control procedures.

People told us that the practice was well-run and provided a good service. A person said, ‘’I always get a smile and a warm welcome. The dental care I get is brilliant.’’ Another person told us, ‘’I have used the practice for the last 10 years and I have yet to be disappointed. Everything is explained fully before I get any treatment.’’

People told us that they were encouraged to be involved in making decisions about their care and treatment. A person said,’’ I needed a number of treatment sessions and I was very pleased with the way everything was explained before I made my decision to go ahead.’’

We found that the provider needed to make improvements to their infection control policy so it reflected current practice requirements and took account of the recommended quality checks and audits to ensure the practice maintained cleanliness and infection control.

We found the provider had made the required checks on staff before they were employed which made sure they were fit to carry out their roles and responsibilities.

The practice offered conscious intravenous sedation for nervous people which allowed them to be sedated without the need for a general anaesthetic and have dental treatment. We found that the provider needed to make improvements to ensure the environment where this procedure was carried out and the equipment and the medicines used met the recommended clinical standards for this procedure.

We found provider had a quality assurance system that gathered, recorded and evaluated information about the service which ensured people received safe and effective care.