We undertook a follow up focused inspection of Dovecot Health Centre on 21 August 2018. 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 carried out by a CQC inspector.

We undertook a comprehensive inspection of Dovecot Health Centre on 22 May 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 in accordance with the relevant regulations 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 Dovecot Health Centre on our website www.cqc.org.uk.

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

As part of this inspection we asked:

• Is it well-led?

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 breach we found at our inspection on 22 May 2018.

Background

Dovecot Health Centre is located in Liverpool and provides NHS treatment to adults and children. A small amount of private dentistry is also offered.

There is level access for people who use wheelchairs and those with pushchairs. Car parking is available in the roads around the practice, with a limited number of spaces immediately outside the building.

The dental team includes two dentists and three dental nurses. The dental nurses also provide reception and administrative support. The practice has two treatment rooms.

The practice is owned by an individual who is the principal dentist there. They 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 two dentists and one dental nurse. We looked at revised and updated practice policies and procedures and other records about how the service is managed.

The practice is open Monday to Thursday from 9am to 12.45pm and from 2pm to 5.30pm. Friday opening times are from 9am to 12.45pm and from 2pm to 5pm.

Our key findings were:

The provider had acted to make improvements in all areas of governance, including those we highlighted as being in breach of regulations. We found:

• There were systems in place to monitor staff training requirements, including updates on infection prevention and control, safeguarding of adults and children and relevant notifications to CQC, and training on the prevention and management of risk of sepsis.

• Risk assessments were in place in respect of any mercury spillage and for use of latex products and sharps.

• Water temperature checks were in place to support the safe manual cleaning of dental instruments.

• The issue of prescription pads was monitored and recorded; all prescriptions issued could be tracked back to individual clinicians.

• All required recruitment checks for all staff were in place.

• Governance systems were in place to ensure oversight of surgery cleaning and to ensure effective infection control and clinical audit.

• Practice policies and procedures had been reviewed and updated, including the safeguarding policy, to include the safeguarding of vulnerable adults.

• Safeguarding training which included help and guidance for staff on recognising potential cases of modern day slavery, was in place.

• The data protection policy had also been updated to take account of the new General Data Protection Regulation, effective from May 2018.

We carried out this announced inspection on 22 May 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

Dovecot Health Centre is located in Liverpool and provides NHS treatment to adults and children. A small amount of private dentistry is also offered.

There is level access for people who use wheelchairs and those with pushchairs. Car parking is available in the roads around the practice, with a limited number of spaces immediately outside the building.

The dental team includes two dentists and three dental nurses. The dental nurses also provide reception and administrative support. The practice has two treatment rooms.

The practice is run by an individual Mr Michael Farandos who is the principal dentist there. They have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run.

On the day of inspection we collected 23 CQC comment cards filled in by patients and spoke with one patient.

During the inspection we spoke with two dentists and two dental nurses, one of whom was acting as the receptionist. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open Monday to Thursday from 9am to 12.45pm and from 2pm to 5.30pm. Friday opening times are from 9am to 12.45pm and from 2pm to 5pm.

Our key findings were:

• The practice appeared clean and well maintained.
• The practice staff had access to infection control policies which reflected published guidance. We found this guidance was not always followed.
• 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. Some risk assessments required completing and others needed further development.
• The practice staff had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children. The training for some staff in this area required updating.
• Training on the prevention of and management of risk of sepsis had not been made available to staff.
• The practice had access to staff recruitment policies which reflected regulatory requirements. This guidance was not always followed.
• The clinical staff provided patients’ care and treatment in line with current guidelines.
• The practice had carried out audits to monitor the quality of patient notes but this required greater follow-up.
• 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.
• 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 practice staff dealt with complaints positively and efficiently.
• Governance arrangements and processes required improvement.

We identified regulations the provider was not meeting. They must:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

Full details of the regulation the provider is not meeting are at the end of this report.

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

• Review the practice’s safeguarding policy and ensure it takes into account both adults and children.

We spoke with four people during our inspection who all told us they were happy with the care and treatment they had received at Dovecot Health Centre. Some comments made were:

“I’ve been with this dentist a long time and they have always been very good”.

“They are great, I only phoned up this morning for an emergency appointment and I’m here now”.

“I have confidence in the dentist and the girls are lovely”.

During our visit we saw that the treatment rooms, decontamination room, waiting area and other communal areas were clean and tidy. We also saw that the instruments and equipment used at the practice were cleaned and decontaminated in line with current best practice guidance.

People who used the service were given clear information about the treatment they would receive and how much it would cost. There were suitable arrangements in place to deal with foreseeable emergencies and all staff had been provided with suitable training and support with which to undertake their roles and responsibilities.