We inspected the service in November 2013 we found the provider did not have systems in place to reduce the risk of infection or to monitor the quality of the service people received. We visited on 14 March 2014 to check what improvements the provider had made. We spoke with the provider and the three members of staff who worked at the practice.

We found the practice environment was generally clean and tidy. The provider and the dental nurse were wearing short sleeved tunics which appeared clean.

The provider had identified the dental nurse as the designated lead for infection prevention and control. The dental nurse demonstrated a clear knowledge and understanding of the systems and arrangements in place.

We saw policies had been updated and reflected the latest guidance and audits had been competed to identify areas for improvement.

Records showed contracts were in place to ensure equipment was serviced and met required standards. Environmental risk assessments were in place to ensure people and staff were protected from risks relating to disposing of waste, radiation and fire.

Dr Baber Khan – The Crescent currently has one dentist. The patients are all private. We visited to check if they were compliant with a warning notice we issued following our visit in 22 January 2013. We spoke with two members of staff and the dentist.

When we visited on 22 January 2013 we saw decontamination processes were not always effective in reducing the risk of infection. We also identified the cleaning schedule did not support identified infection control standards.

When we visited on 18 March 2013 we saw there was a good improvement in the cleanliness of the clinical and non clinical areas. Cleaning processes were in place and records showed daily cleaning was happening.

The decontamination process had been reviewed. A disinfecting cleaning solution was used to scrub dirty instruments and all instruments were visually inspected. Records showed the autoclave was tested and working correctly each day. However, we saw there was no hand washing facilities in the decontamination room.

Dr Baber Khan – The Crescent currently has one dentist. The patients are all private. We spoke with two members of staff, one dentist and a patient who was visiting the service at the time of our visit.

The patient told us the dentist discussed their treatment options. They said, "I always get a treatment plan and have a good idea of what’s happening.”

The patient told us the dentists and dental nurses wore protective equipment, for example gloves, to reduce the risk of infection. However we saw decontamination processes were not always effective in reducing the risk of infection. We also identified the cleaning schedule did not support identified infection control standards.

We saw the emergency medication was not all within their expiry dates. We also saw some of the recommended medication was not available.

Members of staff told us they had not received any training in the last 15 months. They also said they did not have yearly appraisals or regular supervision to support them and indentify training needs.

We saw risks to people were not always identified or managed. Routine audits to monitor the quality of the service provided did not happen.

We visited the service on 18 October 2013 as we had received some information of concerns about the provider. The dental nurse who was the designated infection control lead was not available on 18 October 2013 so we went back to the service on 21 October 2013 to speak with them. We also visited on 8 November 2013 to check compliance with outstanding compliance actions. A specialist advisor who was a dentist visited with us on 18 October 2013 and 8 November 2013.

When we visited on 8 November 2013 the provider informed us all the permanent staff had left their employment and they were working with temporary staff to provide a service to people.

We saw people received the care they needed. They were involved in discussions about their care and were given time to make decisions. One person told us, “You can think about it and the cost.”

Systems for ensuring people were protected from the risk of infection were not always followed correctly. Infection control audits were not completed accurately.

Staff were supported to access training and receive appraisals.

The provider did not have robust arrangements in place to monitor the quality of the service people received. They did not respond to advice from professionals and did not complete appropriate audits to identify areas for improvement.