We undertook a focused inspection of Danny the Dentist on 29 January 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 Danny the Dentist on 3 July 2018 and on the 24 July 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 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 Danny the Dentist dental practice on our website www.cqc.org.uk.

As part of this inspection we asked:

• Is it well-led?

Our findings were:

Are services safe?

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

Are services effective?

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

Are services caring?

We found this practice was providing caring services in accordance with the relevant regulations.

Are services responsive?

Are services well-led?

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

Background

Danny the Dentist is in Weybridge and provides private treatment for adults and children.

There is level no access for people who use wheelchairs and those with pushchairs. Car parking spaces, including for blue badge holders, are available near the practice.

The dental team includes 1 dentist, 2 trainee dental nurses/receptionists and 1 hygiene therapist. The practice has 1 treatment room.

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 Danny the Dentists is the principal dentist. A registered manager is legally responsible for the delivery of services for which the practice is registered.

During the inspection we spoke with 1 dentist and 2 trainee dental nurses/ receptionists. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday 09.00 to 18.00

Tuesday 09.00 to 19.00

Wednesday to Friday 09.00 to 17.00

Some Saturdays 09.00 to 14.00

We carried out this announced inspection on 3 July 2018 and on the 24 July 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 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

Danny the Dentist is in Weybridge and provides private treatment to adults and children.

There is no level access for people who use wheelchairs and those with pushchairs. The surgery is on the first floor with steep stairs and no lift facility. Car parking spaces are street parking or a local car park that is available near the practice.

The dental team includes 1 dentist and 1 volunteer receptionist. The practice has one treatment room, one room for mybrace set up for children and one decontamination room. During the second day inspection a new member of staff, a dental nurse, had been employed and they were spoken with.

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 Danny the Dentist was the principal dentist.

On day one of inspection, we collected 22 CQC comment cards filled in by patients and spoke with one other patient.

During the first day of inspection we spoke with one dentists who is the principal dentist and one volunteer receptionist. On the second day of inspection we also spoke with the dental nurse. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open: Monday 10.00 -19.00. Tuesday 09.00-17.00 Wednesday 09.00-13.00 Thursday 09.00-17.00 Friday 09.00-13.00. one Saturday per month.

Our key findings were:

• The practice appeared clean and well maintained.
• The practice staff had infection control procedures which reflected published guidance.
• Staff knew how to deal with emergencies.
• The practice had some systems to help them manage risk.
• The practice staff did have suitable safeguarding processes and all staff knew their responsibilities for safeguarding adults and children.
• The practice had some staff recruitment procedures.
• 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.
• The practice was providing preventive care and supporting patients to ensure better oral health.
• The appointment system met patients’ needs.
• The practice had some leadership and culture of continuous improvement.
• Staff felt involved and supported and worked well as a team.
• The practice asked staff and patients for feedback about the services they provided.
• The practice staff dealt with complaints efficiently.
• The practice did have some suitable information governance arrangements.

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

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
• Ensure sufficient numbers of suitably qualified, competent, skilled and experienced persons are deployed to meet the fundamental standards of care and treatment.
• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.

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

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

• Review the practice's risk management systems for monitoring and mitigating the various risks arising from the undertaking of the regulated activities.
• Review the practice’s arrangements for ensuring good governance and leadership are sustained in the longer term.
• Review the practice’s protocols for the use of rubber dam for root canal treatment taking into account guidelines issued by the British Endodontic Society.
• Review staff training to ensure that all the staff have received training, to an appropriate level, in the safeguarding of children and vulnerable adults. Reviewed the fire safety risk assessment and ensure that any actions required are complete and ongoing fire safety management is effective. Reviewed staff training to manage medical emergencies taking into account the guidelines issued by the Resuscitation Council (UK) and the General Dental Council.
• Review the practice's responsibilities to take into account the needs of patients with disabilities and to comply with the requirements of the Equality Act 2010.