During our announced comprehensive inspection of this practice on 4 October 2016 we found breaches of legal requirements of the Health and Social Care Act 2008 in relation to regulation 17- Good Governance and regulation 19- Fit and proper persons employed.

We undertook this focused inspection to check that the provider now met legal requirements. This report only covers our findings in relation to these requirements. You can read the report from our previous comprehensive inspection by selecting the 'all reports' link for Dental Surgery at www.cqc.org.uk

Key findings

• Overall, we found that effective action had been taken to address the shortfalls identified at our previous inspection. The provider must now ensure that the newly implemented improvements are embedded and sustained in the long- term in the practice.

We carried out an announced comprehensive inspection on 4 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 not providing safe care in accordance with the relevant regulations.

Are services effective?

We found that this practice was not 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 Dental Surgery is a small, well-established practice that provides mostly NHS general dentistry services to adults and children. Dr Robert Burkett, who is also the principal dentist, owns the practice.

The practice has a team of two dentists, three part-time dental nurses, and two part-time receptionists. There are two treatment rooms, a room for the decontamination of instruments, and a patient waiting and reception area.

The practice opens on Mondays to Fridays from 9am to 5pm, and on Saturdays by appointment. It is closed for lunch between 1 pm and 2 pm.

The practice owner is registered with the Care Quality Commission (CQC) as an individual. 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:

• We received consistently good feedback from patients about the quality of the practice’s staff and the effectiveness of their treatment.

• There was appropriate equipment for staff to undertake their duties and equipment was well maintained.

• Appointments were easy to book and patients requiring urgent treatment were always seen on the same day.

• Staff we spoke to felt well supported by the practice owner, and there were regular practice meetings involving all staff.

• The practice listened to its patients and staff and acted upon their feedback.

• Arrangements for monitoring safety and managing risk were not robust. This included the recording of significant events, the use of a safer sharps’ systems, the use of rubber dams, the storage of dental care products, and the management of substances hazardous to health.

• The practice’s recruitment process did not ensure that all relevant checks were undertaken before new staff started work.

• Essential information and evidence of some dental examinations and risk assessments was missing from patient dental care records.

• Some areas of the practice were not visibly clean.

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

• Ensure effective systems and processes are established to assess and monitor the service against the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and national guidance relevant to dental practice. This must include systems for monitoring safety and reducing risk to patients and staff; maintaining an hygienic environment, ensuring staff are up to date with essential training and ensuring dental care records are maintained appropriately giving due regard to guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.

• Ensure the practice's recruitment policy and procedures are suitable and the recruitment arrangements are in line with Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 to ensure necessary employment checks are in place for all staff and the required specified information in respect of persons employed by the practice is held.

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

• Review staff awareness of the requirements of the Mental Capacity Act (MCA) 2005 and ensure all staff are aware of their responsibilities under the Act as it relates to their role, and in particular to the needs of patients living with dementia.

• Review the practice’s protocols and procedures for promoting the maintenance of good oral health giving due regard to guidelines issued by the Department of Health publication ‘Delivering better oral health: an evidence-based toolkit for prevention’.

• Review the practice’s responsibilities to the needs of people with a disability and the requirements of the Equality Act 2010. Review the availability of interpreting services for patients who do not speak English as their first language.

We spoke with three people using the service after they had received treatment. They all confirmed that the treatment they needed and the fees payable were explained to them before treatment commenced. One person said, “They always tell you what they’re doing.”

One person, who said they were nervous about attending the dentist said, “I am happy with this dentist so I stick with him.” Some patients had first visited this provider when the surgery was located in Great Yarmouth and they had decided to stay with them when they moved to Norwich. One person told us, “I first saw him in Great Yarmouth and continued with him when he moved to Norwich.” They also said, “I do the journey as I’m so pleased with him.”

People told us they were very satisfied with the care and treatment they received. They spoke about the very friendly and welcoming staff. A person said, “I like coming here.”