We carried out an announced comprehensive inspection of this practice on 1 March 2016, during which breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet the legal requirements set out in the following regulations:-

Regulation 13 HSCA (Regulated Activities) Regulations 2014 Safeguarding service users from abuse and improper treatment

Regulation 17 HSCA (Regulated Activities) Regulations 2014 Good governance

We carried out this focused inspection on 22 February 2017 to check the provider had followed their plan and to confirm that they now met legal requirements. We reviewed the requirements in relation to 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 Deva Dental Clinic 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

Deva Dental Clinic is located close to the centre of Chester. The practice comprises a reception and waiting room on the ground floor, two treatment rooms, one of which is situated on the ground floor, a decontamination area. Parking is available at the front of the practice. The practice is accessible for wheelchair users and patients with prams via a ramp at the rear entrance.

The practice provides general dental treatment to patients of all ages on an NHS or privately funded basis and is open Monday to Friday 9.00am to 5.00pm.

The practice is staffed by a dentist, a practice manager / dental nurse, a dental hygienist and a dental nurse / receptionist.

The principal dentist is registered with the Care Quality Commission 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:

• Staff had received safeguarding training, and knew the processes to follow to raise concerns.
• Equipment was well-maintained and tested at regular intervals.
• Staff followed current infection control guidelines.
• Staff were supported to deliver effective care, and opportunities for training and learning were available.
• The practice gathered the views of patients and took their views into account.
• Staff were supervised and worked as a team.
• Governance arrangements, systems and procedures were in place for the smooth running of the practice.

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

• Review the practice’s systems to ensure that risks relating to staff immunisation status are assessed, monitored and mitigated for all staff.

We carried out an announced comprehensive inspection on 1 March 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

Deva Dental Clinic is located close to the centre of Chester and comprises a reception and waiting room on the ground floor, two treatment rooms, one of which is situated on the ground floor, a decontamination area / kitchen / storage room, and staff rooms. Parking is available at the front of the practice. The practice is accessible for wheelchair users and patients with prams via a ramp at the rear entrance.

The practice predominantly provides general dental treatment to NHS patients of all ages with private treatment options available, and is open Monday to Friday 9.00am to 5.00pm.

The practice is staffed by a dentist, a practice manager / dental nurse, a dental hygienist and a dental nurse / receptionist.

The principal dentist is registered with the Care Quality Commission 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.

We received feedback from four patients about the service. The four CQC comment cards we received reflected positive comments about the staff and the services provided. Patients commented that the practice appeared clean and safe and they found the staff polite, caring, and friendly. They commented that the dental treatments were good and said explanations from staff were helpful and informative.

Our key findings were:

• The practice recorded and analysed accidents and complaints and received and acted on safety alerts.
• Staff had not received recent safeguarding training but knew the process to follow to raise any concerns.
• There was an adequate number of suitably qualified staff to meet the needs of patients but not all clinicians were supported by nursing staff on every occasion.
• Staff had been trained to deal with medical emergencies, however emergency medicines and equipment were not appropriately monitored, and some items were unavailable. The missing items were ordered immediately by the provider.
• Improvements were needed to infection prevention and control procedures.
• Improvements were needed for storage of prescription forms and waste.
• Patients’ needs were assessed and care and treatment were delivered in accordance with current legislation, standards and guidance.
• Patients received explanations about their proposed treatment, costs, benefits and risks and were involved in making decisions about it.
• The practice staff worked as a team; however they lacked training for undertaking their roles and support for professional development.
• Patients were treated with dignity and respect and their confidentiality was maintained.
• The appointment system met the needs of patients and waiting times were kept to a minimum.
• Services were planned and delivered to meet the needs of patients and reasonable adjustments were made to enable patients to receive their care and treatment.
• The practice took into account any patient comments, however no formal system for obtaining feedback from patients or staff was in place.
• Governance arrangements, including some systems and processes, were in place for the running of the practice; however several were not operating effectively.
• Policies, procedures and risk assessments were not reviewed and updated in line with current legislation and guidance.
• The practice did not have a structured plan in place to audit quality and safety beyond the mandatory audits for infection control and radiography.

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

• Ensure that systems, processes and training are established and operated effectively to safeguard patients from abuse, and in particular ensure the practice has a safeguarding policy for vulnerable adults.
• Ensure that systems and processes are established and operated effectively to assess, monitor and improve the quality and safety of the services provided.

• Ensure policies, procedures and risks are regularly reviewed and updated where necessary in line with legislation and current practice changes.
• Ensure audits have documented learning points and the resulting improvements can be demonstrated.
• Ensure the practice's recruitment policy accurately reflects the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
• Ensure there is a protocol in place for maintaining accurate, complete and detailed records relating to the employment of all staff. This includes ensuring recruitment checks are carried out and recorded, and securely stored.
• Ensure feedback from patients, staff and other relevant persons is obtained and acted on to evaluate and improve the service.

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 staffing requirements to ensure nursing support is available for all clinicians.
• Review the emergency equipment to ensure the practice has all the recommended items in accordance with the Resuscitation Council UK guidance.
• Review checks on emergency medicines and equipment to ensure they are in accordance with current recommendations.
• Review stocks of medicines and equipment and the system for identifying and disposing of out-of-date stock.
• Review the storage of dental care medicines and materials requiring refrigeration to ensure they are stored in line with the manufacturer’s guidance and the fridge temperature is monitored and recorded.
• Review the security of NHS prescription pads in the practice and ensure there are systems in place to monitor and track their use.
• Review the practice’s infection control procedures and protocols having 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 waste handling policy and procedure to ensure waste is securely stored in accordance with relevant regulations having due regard to guidance issued in the Department of Health - Health Technical Memorandum 07-01 Safe management of healthcare waste.
• Review the practice’s sharps procedures having due regard to the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.
• Establish whether the practice is in compliance with its legal obligations under the Ionising Radiation Regulations 1999 and the Ionising Radiation (Medical Exposure) Regulations 2000.
• Review the training, learning and development needs of individual staff members and establish an effective process for the on-going assessment and supervision of all staff.
• Review the protocols and procedures to ensure staff are up to date with their mandatory training and their continuing professional development.
• Review staff awareness of Gillick competency and ensure all staff are aware of their responsibilities.
• Review the practice’s complaint handling procedures and ensure information is included on the practice’s website as to the steps people can take should they be dis-satisfied with the outcome of their complaint.

People who used the laser clinic and dental surgery told us they were given appropriate information and support regarding their treatment options and costs. They were very positive about the care and treatment they received.

People told us that consultations and treatments were undertaken in private and they felt their dignity was respected and their privacy maintained.

People spoken with also reported that appointments were flexible to meet their needs and the practice was accessible, comfortable, clean and accommodating. Some comments made about the laser clinic were; -

“It’s a really good, professional service. The procedure was explained along with any side effects. The costs were fully explained.”

Some comments made about the dental surgery were; -

“This is a good service. The dentist and nurse are very good they put me at ease.”

“Treatments are explained. The dentist is very good.”

“I think the service is the best.”

We asked the Cheshire, Warrington and Wirral Primary Care Team for information about how the dental service was operating. No issues of concern were reported.