We carried out an announced comprehensive inspection on 23 August 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

Dental Surgery provides NHS and private dental treatment to patients of all ages. The services provided include preventative advice and treatment and routine dental care.

The practice staffing consists of a principal dentist, one dental nurse, two hygienists and a receptionist.

The principal dentist is registered with the Care Quality Commission (CQC) as an individual registered person. 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.

The practice consists of three treatment rooms, a waiting area for patients and reception area and a staff room.

The practice opening hours are Monday to Friday 9am to 5pm.

32 patients provided feedback about the service. Patients we spoke with and those who completed comment cards were very positive about the care they received and about the service. Patients told us that they were happy with the dental treatment and advice they had received.

Our key findings were:

• Patients’ care and treatment was planned and delivered in line with current legislation and evidence based guidelines such as from the National Institute for Health and Care Excellence (NICE).
• There were sufficient numbers of suitably qualified staff to meet the needs of patients.
• Patients were treated with dignity and respect and patient confidentiality was maintained.

• The practice had a procedure for handling and responding to complaints.

• The practice had arrangements for receiving and responding to patient safety alerts issued from relevant external agencies.
• The practice had whistleblowing policies and procedure and staff were aware of these and their responsibilities to report any concerns.
• The practice had ensured that appropriate equipment in line with Resuscitation Council (UK) guidance, was available to respond to a medical emergency.
• Staff had not undertaken training in key areas such as safeguarding children and adults, infection control and basic life support. There was lack of oversight of staff’s continuing professional development (CPD) activity and it was not being suitably monitored.
• Infection control protocols were not being followed in line with recommended national guidance.

• There were systems in place to ensure that equipment including the suction apparatus, compressor unit, autoclaves and X-ray unit was maintained; however fire extinguishers had not been serviced regularly and PAT (portable appliance testing) had not been carried out.

• Governance systems were not effective. The practice had not carried out audits in key areas, such as radiography and record keeping. The practice had carried out limited risk assessments to safeguard the health and safety of staff and patients.

• The practice had not ensured that all the specified information relating to persons employed at the practice was obtained and appropriately recorded.
• Dental care records were not being suitably completed in line with guidance provided by the Faculty of General Dental Practice.

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

• Ensure an effective system is established to assess, monitor and mitigate the various risks arising from undertaking of the regulated activities.

• Ensure systems are in place to assess, monitor and improve the quality of the service.

• Ensure audits of various aspects of the service, such as radiography, infection control and dental care records are undertaken at regular intervals to help improve the quality of service. The practice should also ensure that where appropriate audits have documented learning points and the resulting improvements can be demonstrated.

• 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.

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 practice's safeguarding policies and staff training and ensure all staff are aware of their responsibilities.
• Review the practice’s infection control procedures and protocols taking into account 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’
• Review the practice's protocols for completion of dental care records taking into account guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.
• Review stocks of medicines and equipment and the system for identifying and disposing of out-of-date stock.
• 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.

People using the dental practice told us that they were happy with the services that they received. They felt they were given enough information about their treatment options and any relevant costs.

We had positive feedback throughout our inspection which included, “I have used Barry for over four years, I bring my granddaughter here and we are very pleased with the service. The treatments are explained to you and he talks you through the process”.

Other comments included; “The practice is clean and I get seen on time”.

“We are happy here and would not go elsewhere as the staff make you feel comfortable”.

“We feel safe here as it is not always easy to find a good reliable dentist”.

We looked at the feedback from the most recent questionnaires (2011-2012) and found only positive comments. They included; “The staff are professional” “I have been at this surgery since 1977 and would not change” “I get seen on time” and “I rate this surgery”.

We carried out a follow- up inspection on 18 April 2017 at Dental Surgery

We had undertaken an announced comprehensive inspection of this service on 23 August 2016 as part of our regulatory functions where breach of legal requirements was found.

After the comprehensive inspection, the practice wrote to us to say what they would do to meet the legal requirements in relation to the breach.

We revisited Dental Surgery, Dental Practice as part of this review and checked whether they had followed their action plan.

We reviewed the practice against one of the five questions we ask about services: is the service well-led? This report only covers our findings in relation to those requirements.

You can read the report from our last comprehensive inspection by selecting the 'all reports' link for Dental Surgery Practice on our website at www.cqc.org.uk.

Background

This inspection was planned to check whether the practice was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

This inspection was carried out to check that improvements to meet legal requirements planned by the practice after our comprehensive inspection on 23 August 2016 had been made.

The follow up inspection was led by a CQC inspector who had access to remoteadvice from a specialist advisor.

During our inspection visit, we checked that points described in the provider’s action plan had been implemented by looking at a range of documents such as risk assessments, staff files, policies, procedures and staff training. We also carried out a tour of the premises.

Our key findings were:

• The practice had infection control procedures which reflected published guidance.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• The practice had systems to help them manage risk.
• The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• The practice had thorough staff recruitment procedures.
• The clinical staff provided patients’ care and treatment in line with current guidelines.
• The practice had effective leadership. Staff felt involved and supported and worked well as a team.
• The practice asked staff and patients for feedback about the services they provided.