We undertook a follow up desk-based inspection of Dentith and Dentith Dental Practice on 18 March 2019. This inspection was carried out to review in detail the actions taken by the registered provider to improve the quality of care and to confirm that the practice was now meeting legal requirements.

The inspection was led by a CQC inspector.

We undertook a comprehensive inspection of Dentith and Dentith Dental Practice on 16 August 2018 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We found the registered provider was not providing well led care and was in breach of regulation 17 and 19 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 Dentith and Dentith Dental Practice on our website www.cqc.org.uk.

As part of this inspection we asked:

• Is it well-led?

When one or more of the five questions are not met we require the service to make improvements and send us an action plan (requirement notice only). We then inspect again after a reasonable interval, focusing on the area(s) where improvement was required.

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 in relation to the regulatory breaches we found at our inspection on 16 August 2018.

Background

Dentith and Dentith Dental Practice is located in Oakham, the county town of Rutland. It mainly provides private treatment to adults and children and also has an NHS contract to provide treatment to children only.

There is level access for people who use wheelchairs and those with pushchairs. There is no car parking facility on site. Parking spaces, including those for blue badge holders, are available in local car parks and on the road within close proximity to the practice.

The dental team includes four dentists, eight dental nurses, two trainee dental nurses, two dental hygienists and a practice manager.

The practice has five treatment rooms; one is on the ground floor.

The practice is owned by a partnership and as a condition of registration must have a person registered with the Care Quality Commission as the registered manager. Registered managers 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 registered manager at Denith and Dentith Dental Practice is the practice manager.

During the inspection we spoke with the practice manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open: Monday to Thursday from 8.30am to 5.15pm and Friday 8.30am to 12.30pm.

Our key findings were:

• Systems and processes had improved in relation to the reporting and investigating of significant events and near misses.

• The provider demonstrated that systems for audit had improved; we were provided with evidence of audits completed.

• All staff had received an appraisal; this included objectives and their training requirements.

• The Mental Capacity Act had been discussed with staff to increase their knowledge and understanding.

• There was a system for receiving and reviewing patient safety alerts.

• Risks presented by fire had been appropriately mitigated; an external contractor was utilised to complete a risk assessment and a five yearly fixed wiring safety inspection had been completed.

• Staff recruitment processes had been improved to ensure compliance with legislative requirements.

• A hearing loop had been purchased and the practice had contact information for an interpreter service.

We carried out this announced inspection on 16 August 2018 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

Dentith and Dentith Dental Practice is located in Oakham, the county town of Rutland. It mainly provides private treatment to adults and children and also has an NHS contract to provide treatment to children only.

There is level access for people who use wheelchairs and those with pushchairs. There is no car parking facility on site. Parking spaces, including those for blue badge holders, are available in local car parks and on the road within close proximity to the practice.

The dental team includes four dentists, eight dental nurses, two trainee dental nurses, two dental hygienists and a practice manager.

The practice has five treatment rooms; one is on the ground floor.

The practice is owned by a partnership and as a condition of registration must have a person registered with the Care Quality Commission as the registered manager. Registered managers 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 registered manager at Denith and Dentith Dental Practice is the practice manager.

On the day of inspection we collected 12 CQC comment cards filled in by patients.

During the inspection we spoke with four dentists, three dental nurses, one trainee dental nurse, one dental hygienist and the practice manager. We looked at practice policies and procedures, patient feedback and other records about how the service is managed.

The practice is open: Monday to Thursday from 8.30am to 5.15pm and Friday 8.30am to 12.30pm.

Our key findings were:

• The practice appeared clean and well maintained.
• The provider 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 some systems to help them manage risk to patients and staff. We identified areas that required strengthening to ensure that all risks were identified and appropriate mitigating action taken.
• The practice staff had mostly suitable safeguarding processes. Staff demonstrated awareness of their responsibilities for safeguarding adults and children. We found that one member of staff had not updated their safeguarding training within the last three years. This was updated following our inspection.
• Staff recruitment procedures required strengthening. We found that not all appropriate checks had been undertaken at the point of recruitment.
• The clinical staff provided patients’ care and treatment in line with current guidelines.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• The practice was providing preventive care and supporting patients to ensure better oral health.
• The appointment system met patients’ needs.
• The practice demonstrated some elements of effective leadership; we noted that this area also required development.
• Staff felt involved and supported and worked well as a team.
• The practice asked staff and patients for feedback about the services they provided.
• The provider had systems to deal with complaints.

We identified regulations the provider was not complying with. 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.

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

• Review the practice's responsibilities to take into account the needs of patients with disabilities and to comply with the requirements of the Equality Act 2010.