We carried out a focused inspection of Daventry Dental Care on 14 June 2018

The inspection was led by a CQC inspector who had assistance from a dental clinical adviser.

We carried out this inspection to follow up concerns we originally identified during a comprehensive inspection at this practice on 20 December 2017. We carried out this inspection 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 Daventry Dental Care on our website www.cqc.org.uk.

We also reviewed aspects of the key questions of safe and effective as we had made recommendations for the provider relating to these key questions. These particularly related to issues concerning the use of safer sharps, the use of rubber dam for root canal treatment, X-ray audits, staff training in the Mental Capacity Act 2005 and installing an induction hearing loop to assist patients who used a hearing aid. We noted that improvements had been made.

Our key findings were:

• The system and processes for dealing with significant events had been reviewed.
• Risk assessments for Legionella and fire had been completed since the last inspection in December 2017.
• The practice received Medicines and Healthcare Products Regulatory Authority (MHRA) alerts.
• Policies were practice specific.
• Staff files contained all of the information required by Schedule 3 of the Health and Social Care Act 2008 Regulations.
• Audits for key areas of activity had been completed and action plans produced.

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

• Review its responsibilities to the needs of people with a disability, including those with hearing difficulties and the requirements of the Equality Act 2010.

• 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.

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 20 December 2017.

We carried out this announced inspection on 20 December 2017 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

The practice is based in Daventry, a market town in Northamptonshire. It provides NHS and private treatment to patients of all ages.

There is currently no access for wheelchair users and families with pushchairs. Building work has recently commenced to convert the premises and make them accessible for all people. The practice does not have patient parking facilities but public car parks are available near to the practice.

The dental team includes four dentists, five dental nurses, one trainee nurse, two dental hygienists, two receptionists, a practice administrator and an administrative support staff member.

The practice has three treatment rooms.

The practice is owned by an individual who is the principal dentist there. They have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run.

On the day of inspection we collected 38 CQC comment cards filled in by patients. This information gave us a positive view of the practice.

During the inspection we spoke with two dentists, two dental nurses, two receptionists and the practice administrator. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open: Monday, Wednesday, Thursday from 9am to 5pm for NHS patients (and closes at 6pm for private patients) Tuesday from 8am to 5pm for NHS patients (and closes at 6pm for private patients) Friday from 9am to 3pm for both NHS and private patients and Saturday from 9am to 1pm for private patients only.

Our key findings were:

• The practice objectives included the provision of high quality dental treatment to the whole population; with a focus on prevention of dental disease by promoting oral health care and providing advice.
• Staff had been trained to deal with medical emergencies and appropriate medicines and lifesaving equipment was available in accordance with current guidelines.
• The practice appeared clean and was generally well maintained.
• Staff demonstrated awareness of their responsibilities for safeguarding adults and children living in vulnerable circumstances.
• The practice had not adopted a robust process for the reporting of untoward incidents.
• Clinical staff provided dental care in accordance with current professional and National Institute for Health and Care Excellence (NICE) guidelines.
• Staff recruitment processes did not comply with legislative requirements or the practice policy.
• Patients had access to routine treatment and emergency care when required.
• Staff received training appropriate to their roles and there was evidence of continuing professional development.
• The practice responded to complaints received, but we noted that records held were not all complete.
• We found areas where ineffective leadership was in place and governance arrangements required strengthening.

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 recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.

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 sharps procedures and ensure the practice is in compliance with the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.
• 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 the practice’s protocols for recording in the patients’ dental care records or elsewhere the reason for taking the X-ray and quality of the X-ray ensuring compliance with the Ionising Radiation (Medical Exposure) Regulations (IRMER) 2000.
• Review staff awareness of the requirements of the Mental Capacity Act (MCA) 2005 and the principle of young people’s competency and ensure all staff are aware of their responsibilities as it relates to their role.
• Review its responsibilities to the needs of people with a disability, including those with hearing difficulties and the requirements of the Equality Act 2010.

We were not able to speak to people at the time of our inspection, however we looked at feedback provided by people who use the service which was positive. People stated staff were extremely friendly and made them feel at ease.

We were not able to speak to people at the time of our inspection, however we looked at feedback provided by people who use the service which was positive. People stated staff were extremely friendly and made them feel at ease. Some people complained that the practice was on not on the ground floor and the stairs were difficult to climb.

We were not able to speak to people at the time of our inspection, however we looked at feedback provided by people who use the service which was positive. People stated staff were extremely friendly and made them feel at ease. Some people complained that the practice was on not on the ground floor and the stairs were difficult to climb.