We did a comprehensive inspection at this practice on 14 December 2016 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We found the registered provider was providing safe, effective, caring and responsive care in accordance with relevant regulations.

We judged that 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 David Holloman Dentistry – High Street Bromyard on our website www.cqc.org.uk.

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 questions is not met, we check whether the provider has made the required improvements by doing a focused inspection after a suitable time interval.

At a focused inspection of David Holloman Dentistry on 5 May 2017 we checked whether the service was now well-led and whether the provider was meeting regulation 17.

Are services well-led?

We found that the provider had taken effective action to deal with the shortfalls we found at our inspection on 14 December 2016. We found that this practice was providing well-led care in accordance with regulation 17.

We carried out an announced comprehensive inspection on 14 December 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

The registered provider for David Holloman Dentistry is the director of David Holloman Dentistry Limited which has an expense sharing partnership with another dentist, Ann Smith. Locally the practice is known as Smith, Holloman and Associates and operates as one practice. When a practice operates as an expense sharing partnership the individual providers are registered with CQC separately and we write separate inspection reports. This report is about David Holloman Dentistry. We inspected Ann Smith’s practice on the same day and that report is also available. Most information we obtained was common to both and we therefore use the term ‘the practice’ in this report unless something is specific only to David Holloman Dentistry.

The practice is situated in the town centre of Bromyard in Herefordshire and has been a dental practice since the late 1800s. The practice mainly provides NHS dental treatment for all age group. It also provides some private treatment.

David Holloman is the registered manager and sole dentist at David Holloman Dentistry Ltd. In this report we refer to him as 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.

David Holloman Dentistry Ltd employs one part time dental hygienist and shares the employment of a practice manager, six dental nurses, a trainee dental nurse, a reception team and cleaner with the other registered provider at the practice.

The overall practice accommodation includes four dental treatment rooms and a separate decontamination room for the cleaning, sterilising and packing of dental instruments. The treatment room normally used by David Holloman Dentistry is on the first floor. Reception staff are able to arrange for patients to be seen in a ground floor treatment room if they are unable to walk up the stairs. The waiting room is separate from the reception area which helps provide privacy when staff are dealing with patients at the reception desk or on the telephone.

Appointments with David Holloman Dentistry are available from 9am to 7.30pm on Mondays, 9am to 5.30pm from Tuesday to Thursday and 8.30am to 5.30pm on Fridays. The other provider at the practice also opens from 9am to 1pm every fourth Saturday and sees patients of David Holloman Dentistry if needed. The practice closes for lunch from 1pm to 2pm.

Before the inspection we sent Care Quality Commission comment cards to the practice so patients could give us their views about it. We collected 23 completed cards specific to David Holloman Dentistry Ltd. Patients said they were pleased with the service they received and that the practice team were professional, kind and courteous. Some patients mentioned that they were kept informed about their treatment and that the dentist explained everything to them. Those that commented on cleanliness confirmed that the practice was clean and hygienic. A number of patients commented that they had been patients at the practice for many years and some said they were so pleased with their care they were happy to travel long distances for their appointments. The practice provided their NHS Friends and Family Test results since January 2016. These related to the whole practice and showed that all of the 32 patients who took part were extremely likely or likely to recommend the practice.

Our key findings were:

• The practice was visibly clean and feedback from patients confirmed this was their experience. National guidance for cleaning, sterilising and storing dental instruments was followed.
• The practice had suitable safeguarding processes and staff understood their responsibilities for safeguarding adults and children. The safeguarding policy was overdue for review.
• The practice had the recommended medicines and equipment needed for dealing with medical emergencies.

• Staff received training appropriate to their roles and were supported to meet the General Dental Council’s continuous professional development requirements.

• Patients were able to make routine and emergency appointments when needed and gave us positive feedback about the service they received.

• The practice used the NHS Friends and Family Test to enable patients to give their views about the practice. Results during 2016 showed that patients would recommend the practice.

• The practice had policies, procedures and some risk assessments to help them manage the service but these were not comprehensive or regularly reviewed to ensure they were up to date. Some were not fully tailored to reflect the specific circumstances at the practice. There was no fire risk assessment.

• Recruitment procedures did not include specific information about the required information for staff employed.

• The practice used audits as a means to monitor quality in a range of areas and make improvements to the service.

• The practice had limited governance arrangements in place to monitor and assess the quality and safety of the services provided.

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

Ensure that there are systems in place to monitor and improve the quality of services and assess and mitigate the risks to the health, safety and welfare of patients. This includes procedures to:

• 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 from other relevant bodies such as Public Health England (PHE).
• Ensure the arrangements for fire safety at the practice are effective by arranging the completion of a fire risk assessment by a suitable qualified and competent person and the introduction of fire safety records.
• Ensure effective governance arrangements for the day to day management and administration of the practice. This should take into account the full range of management and administrative tasks needing improvement including staff appraisal arrangements and reviewing and updating the practice’s policies, procedures and risk assessments.

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

• Review the arrangements for monitoring and recording of the temperature of the refrigerator used to store temperature sensitive medicines and dental materials.

• Review the practice's recruitment arrangements so these fully reflect relevant legislation and guidance and set out the information required in respect of persons employed by the practice.

• Review arrangements for making reasonable adjustments at the practice to meet the needs of people with a disability with reference to the requirements of the Equality Act 2010.
• Review the carpeted areas in two treatment rooms giving  due regard to the guidelines issued by the Department of Health  in - the 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’

David Holloman is one of three partners at the Smith, Coleman and Holloman dental practice in Bromyard. The three dentists are registered with us separately and so although we inspected all three on the same day we write separate inspection reports about their services. This report is about David Holloman. We have written separate reports for Ann Smith and for Chris Coleman.

Following our visit to the practice we spoke on the telephone with four people who go to David Holloman for their dental care. The people we spoke with were pleased with the service that they received. One person told us, “he definitely makes me feel at ease – he has all the time in the world for you”. Another said, “absolutely excellent, I can’t fault him I must be honest”.

We asked people whether their dentist gave them clear information about the dental care and treatment they or their children needed and any costs involved in this. People said that the dentist was good about doing this and their treatment was explained to them well. One person said “he explains things very well, putting it in simple terms with no dental jargon; he tells you exactly what he’s going to do”. People also confirmed that the dentist checks with them whether their health has changed and that they were asked to fill in a form about this and check it at each visit.

Two people told us that their children had been treated well. On of them whose children were still small told us the dentists was, “absolutely fantastic with the children – they love it – they fight to sit in the chair”.

People confirmed that the dentists and dental nurses wore protective clothing such as face masks and gloves. They said that they were given protective goggles to wear during their treatment. People told us that the practice was always clean and hygienic.

We were provided with a large amount of documents to look at when we arrived for our visit. Whilst much of this was relevant and helpful we noted that some of the paperwork was a number of years old. This made it harder for us to check the most up to date information. We commented to staff that this also meant that some of their records were taking up more space than necessary and could also make it harder for them to find information themselves.