We carried out a comprehensive inspection of this practice on 10 February 2016. Breaches of legal requirements were found. After the inspection, the practice wrote to us to say what they would do to meet legal requirements in relation to premises and equipment.

We undertook this focused inspection on 17 August 2016 to check that they had followed their plan and to confirm that they now met legal requirements. 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 Dentcare1 - Boston on our website at www.cqc.org.uk.

Our findings were:

Are services well-led?

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

Background

Dentcare1 is a private dental surgery located in the town of Boston in Lincolnshire. The building had been occupied as a dentist since the 1950’s. The practice has a large and spacious reception area with chairs and sofas throughout the waiting area. The practice is on two floors however all treatment is provided on the ground floor with offices, staff room and staff toilet on the first floor. There were also three treatment rooms that were not in use on the first floor. These were not decommissioned as the practice said that they may use them if they expanded in the future. There is pay and display parking available nearby. The main entrance to the practice is at the rear of the building. There is a separate entrance that patients with wheelchairs and limited mobility can use which enables access to the treatment rooms however this would be accessed after checking in at the reception area. The practice provides general dentistry, sedation and implants.

There are two dentists, one that works part time at this practice two days per week and one that is full time. There are also three trainee dental nurses and one dental nurse that is also the registered manager and practice manager. The trainee dental nurses have a dual role and also cover reception.

The practice provides private dental treatment to adults and to children. The practice is open Monday to Friday from 9am to 5pm.

The practice manager is 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.

During the inspection we spoke with the practice manager, team leader and dentist.

Our key findings were:

• All staff had been trained in basic life support in May 2016.
• Staff had completed safeguarding training and knew the process to follow to raise any concerns.
• The safeguarding lead has completed level 2 safeguarding training.
• Recent recruitment had followed practice policy and included DBS and references.
• Audit procedures had been improved and future audit templates included an action plan.
• Infection control audit had taken place and actions identified had been completed.

We carried out an announced comprehensive inspection on 10 February 2016 and 19 Febuary 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

Dentcare1 is a private dental surgery located in the town of Boston in Lincolnshire. The building had been occupied as a dentist since the 1950’s. The practice has a large and spacious reception area with chairs and sofas throughout the waiting area. The practice is on two floors however all treatment is provided on the ground floor with offices, staff room and staff toilet on the first floor. There were also three treatment rooms that were not in use on the first floor. These were not decommissioned as the practice said that they may use them if they expanded in the future. There is pay and display parking available nearby. The main entrance to the practice is at the rear of the building. There is a separate entrance that patients with wheelchairs and limited mobility can use which enables access to the treatment rooms however this would be accessed after checking in at the reception area. The practice provides general dentistry, sedation and implants.

There are two dentists, one that works part time at this practice two days per week and one that is full time. There are also three trainee dental nurses and one dental nurse that is also the registered manager and practice manager. The trainee dental nurses have a dual role and also cover reception.

The practice provides private dental treatment to adults and to children. The practice is open Monday to Friday from 9am to 5pm.

The practice manager is 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.

The provider has two other practices and the registered manager works across all three sites with one day per week spent at this practice. One of the trainee dental nurses is also the team leader and is involved in the day to day running of the practice in the absence of the registered manager.

We received feedback from five patients about the services provided. The feedback reflected positive comments about the staff and the services provided. Patients commented that the practice was clean and tidy. They said that they found the staff offered a caring service and that staff were friendly. Patients said that explanations about their treatment were clear and that treatment was always discussed.

Our key findings were:

• There were sufficient numbers of suitably qualified staff to meet the needs of patients at present.
• Infection control procedures were in place and staff had access to personal protective equipment.
• Patients were treated with dignity and respect and confidentiality was maintained.
• The appointment system met the needs of patients and waiting times were kept to a minimum where possible.
• Conscious sedation was delivered safely in accordance with current guidelines.
• The practice did not open any late nights or weekends.
• Not all staff had been trained to deal with medical emergencies.
• Appropriate medicines and life-saving equipment were readily available and accessible.
• Policies and procedures were in place however these were not all practice specific.
• Not all staff had not received safeguarding training or knew the processes to follow to raise any concerns.
• The safeguarding lead was unaware that they were the lead and had not completed any safeguarding training.

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 that all staff have completed mandatory training including safeguarding and basic life support.
• Ensure there is an effective approach for identifying where quality and/or safety is being compromised and steps are taken in response to issues.

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

• Review the protocol for completing accurate, complete and detailed records relating to employment of staff. This includes making appropriate notes of verbal reference taken and ensuring recruitment checks, including references, are suitably obtained and recorded..
• Review the practice’s protocols for the use of rubber dam for root canal treatment giving due regard to guidelines issued by the British Endodontic Society.
• Review the practice’s infection control procedures and protocols giving due regard to 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 practices’ current Legionella risk assessment and implement the required actions giving due regard to 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 giving due regard to guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.
• Review its complaint handling procedures and establish an accessible system for identifying, receiving, recording, handling and responding to complaints by service users.
• Review its audit protocols to ensure audits including of dental care records are undertaken at regular intervals to help improve the quality of service. Practice should also ensure, that where appropriate audits have documented learning points and the resulting improvements can be demonstrated.
• 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.

Dentcare1 – Boston is located in Boston in Lincolnshire. It currently has one full time and two part time dentists. The patients are all private.

We spoke with four members of staff, one dentist and two patients who were visiting the service at the time of our visit.

Patients told us the dentists discussed their treatment options and allowed them to take time to come to a decision. One patient told us, “He [the dentist] talked through what needs to be done.”

Patients told us the dentists and dental nurses wore protective equipment to reduce the risk of infection. One patient said, “He [the dentist] and his assistant always wear a mask and gloves.”