We carried out an announced comprehensive inspection on 4 July 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

Diplomat Dental Care is a dental practice providing NHS and private treatment for both adults and children. The practice is situated in Blandford Forum, a town in Dorset.

The practice has five dental treatment rooms in use and a separate decontamination room used for cleaning, sterilising and packing dental instruments.

The practice is based in an adapted domestic dwelling.

The practice employs three dentists, one hygienist, six dental nurses of which four are trainees and a practice manager.

The practice’s opening hours are between 8am and 5pm on Monday, Wednesday and Thursday, 9am and 5.30pm on Tuesday, between 8am and 4.30pm on Friday and 8.30am and 12.30pm on Saturday.

There are arrangements in place to ensure patients receive urgent medical assistance when the practice is closed. This is provided by an out-of-hours service.

There was no registered manager at the time of our inspection at this location. We were told that the current Practice Manager was going through the CQC registration process to become 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.

We obtained the views of nine patients on the day of our inspection.

Our key findings were:

• We found that the practice ethos was to provide patient centred dental care in a relaxed and friendly environment.

• Leadership was provided by an empowered practice manager.

• Staff had been trained to handle emergencies and appropriate medicines and life-saving equipment was readily available in accordance with current guidelines.

• The practice appeared clean and well maintained.

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

• Infection control procedures were robust and the practice followed published guidance.

• The practice had a safeguarding lead with effective processes in place for safeguarding adults and children living in vulnerable circumstances.

• There was a process in place for the reporting and shared learning when untoward incidents occurred in the practice.

• Dentists provided dental care in accordance with current professional and National Institute for Care Excellence (NICE) guidelines.

• The service was aware of the needs of the local population and took these into account in how the practice was run.

• Patients could access treatment and urgent and emergency care when required.

• Staff received training appropriate to their roles and were supported in their continued professional development (CPD) by the company.

• Staff we spoke with felt well supported by the practice manager and were committed to providing a quality service to their patients.

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

• Ensure the practice 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 the availability of a hearing loop for patients who are hearing aid users.
• Review the current staffing arrangements to ensure all dental care professionals are adequately supported by a trained member of the dental team when treating patients in a dental setting.
• 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 records taking into account guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.
• Review the company’s web site to ensure that it contains up to date information including opening hours and the emergency out of hours contact telephone number for patients.
• Improve the security of the door into the decontamination room to prevent unauthorised access by members of the general public and provide an annual statement in relation to infection prevention control required under The Health and Social Care Act 2008.
• Review the frequency of staff meetings to ensure all staff attend.
• Review the responsibilities to meet the needs of disabled patients and the requirements of the Equality Act 2010 with respect to patient access and toilet facilities.

Further to the outcome of a previous inspection, carried out in July 2016, we carried out an announced focused inspection relating to the safe and well led provision of services on 3 August 2016 to ask the practice the following key questions;

Are services well-led in relation to governance; specifically staff recruitment?

Our findings were:

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

Background

CQC inspected the practice on 3 July 2016 and asked the provider to make improvements regarding:

• Regulation 19 HSCA (RA) Regulations 2014 Fit and Proper Persons employed

We checked this area as part of this focused inspection and found this had been resolved.

Diplomat Dental Care is a dental practice providing NHS and private treatment for both adults and children. The practice is situated in Blandford Forum, a town in Dorset.

The practice has five dental treatment rooms in use and a separate decontamination room used for cleaning, sterilising and packing dental instruments.

The practice is based in an adapted domestic dwelling.

The practice employs three dentists, one hygienist, six dental nurses of which four are trainees and a practice manager.

The practice’s opening hours are between 8am and 5pm on Monday, Wednesday and Thursday, 9am and 5.30pm on Tuesday, between 8am and 4.30pm on Friday and 8.30am and 12.30pm on Saturday.

There are arrangements in place to ensure patients receive urgent medical assistance when the practice is closed. This is provided by an out-of-hours service.

There was no registered manager at the time of our inspection at this location. We were told that the current Practice Manager was going through the CQC registration process to become 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 inspection was carried out by a CQC inspector.

Our key findings were:

• Staff recruitment files contained essential information in relation to Regulation 19, Schedule 3 of Health & Social Care Act 2008 (Regulated Activities) Regulations 2015.

We carried out an announced comprehensive inspection on 18 August 2015 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 this practice was not providing safe care in accordance with the relevant regulations.

Are services effective?

We found this practice was not providing effective care in accordance with the relevant regulations

Are services caring?

We found this practice was providing caring services in accordance with the relevant regulations.

Are services responsive?

We found this practice was providing responsive care in accordance with the relevant regulations.

Are services well-led?

We found this practice was not providing well-led care in accordance with the relevant regulations.

Diplomat Dental Care is part of the provider Southern Dental Limited. The location provides care and treatment for approximately 19000 patients. The practice provides predominantly NHS treatment, some private treatment and treatment under a private dental plan provider. Treatment includes implants, and general dentistry, for example fillings. The practice has four dentists, one hygienist and four dental nurses, including one trainee dental nurse. The clinical team are supported by three reception staff. The practice has five treatment rooms and a separate decontamination room. The practice is open on weekdays between 9am and 5pm, until 7pm on Tuesdays and between 9am and 1pm on Saturdays. Arrangements are in place for emergency consultations when needed.

Diplomat Dental Centre did have a registered manager in post but that person is no longer working at the practice. 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 practice did not have a practice manager in post; cover is being provided on a temporary basis by another manager.

A total of 20 people provided feedback about the service. These included staff members and patients we spoke with on the day, as well as comments cards which had been completed in the two weeks prior to our visit. The feedback was not positive and many remarked on the decline in service provision since the practice had changed providers. Comments related to cancelled appointments, lack of equipment and a high staff turnover.

Our key findings were:

• Patients commented positively about the care and treatment they received and the professional and caring attitude shown by staff. However, they were concerned with the cancelled appointments, staff turnover and delays in treatment.

• The practice did not have suitable arrangements in place to ensure safeguarding training for staff was carried out regularly.
• Appropriate checks were not consistently carried out prior to a member of staff commencing employment.
• Risk assessments related to health and safety had been carried out consistently.
• The practice did not have sufficient supplies of instruments to ensure procedures were carried out safely.
• We observed patients were treated with dignity and respect and staff addressed patients using their preferred name or title
• The practice ensured that patients were given information about their proposed treatment to enable them to give informed consent.
• The practice had all the surgeries situated on the ground floor so it was accessible to patients with mobility difficulties and the toilet on the ground flow was wheelchair accessible.
• The reception counter was purpose built at a low level making it easier to communicate with patients that were in wheelchairs.
• The practice provided general dentistry and implants and referred patient to other dentists with the appropriate qualifications that worked within the provider organisation.
• Appointments times were varied and some extended hours appointments were available and there was a system for patients to obtain same day treatment in an emergency, which included a half hour appointment.

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

• Ensure that appropriate systems and training are in place to safeguard patients from harm.
• Ensure that a full medical history of patients is taken at their first appointment and updated regularly.
• Ensure that records required for the provision of the regulated activity are accurate and maintained.

• Ensure that there is a sufficient supply of instruments to carry on the regulated activity.
• Implement all the recommendations of the fire risk assessment carried out in 2013.

• Ensure that there are sufficient numbers of staff for the running of the service.
• Ensure all appropriate checks are carried out prior to a member of staff commencing employment.
• Ensure risks identified at during the recruitment process are properly assessed and managed.
• Ensure suitable and robust governance systems are in place and action plans are implemented and followed.

You can see full details of the regulations not being met at the end of this report.

We carried out an inspection in December 2013 and found shortfalls in the infection control processes used by the surgery.

We carried out this announced inspection to monitor compliance with the regulations.

We spoke with the practice manager and made a tour of the premises. We found that action had been taken to address the shortfalls.

There were suitable processes in place to ensure used instruments were cleaned, sterilised and appropriately stored.

Areas of the practice which had damp coming through the walls had been treated and redecorated to ensure that risk of infection was minimised.

The practice had three dentists and three dental nurses who provided dental treatment. We spoke with seven people to gain their views and experience of the service and treatment received from their dentist. All people were complimentary about the service received. One person commented, "I have being using this dentist for many years and am happy with the treatment they give me." Another person said, "I came here recently for emergency treatment and have now made them my regular dentist."

People told us they could express their views and were given the information necessary to make informed decisions about their treatment. We looked at six individual dental treatment records. All showed the reasons why treatment was recommended, people's agreement to treatment choices and any oral health advice given.

There were procedures in place to clean and sterilise dental equipment to minimise the risk of people getting an infection. Staff had received regular training to prevent the risk of infection. Staff spoken with were aware of their responsibilities in reducing the risk of infection within the practice. However there was damp and a hole in the wall in one clinical area which required attention

Staff felt well supported in their professional development and training by the provider and practice manager. However staff did not feel they were supported by the provider, and had to repeatedly request equipment necessary to do their jobs safely.