We carried out this announced inspection on 26 April 2018 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We announced this inspection two days prior in response to information of concern received from a whistle-blower. 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 not 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

Fawdon dental practice is in Newcastle Upon Tyne and provides NHS and private treatment to patients of all ages.

There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces are available near the practice.

The dental team includes a principal dentist, an associate dentist and three trainee dental nurses (one of whom is also the practice manager). All dental nurses also undertake reception duties. 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 the associate dentist, the practice manager, a trainee dental nurse and a qualified locum dental nurse. The principal dentist was abroad on the inspection day and was communicating with us regularly via telephone and email. The practice manager told us the principal dentist works at the practice for a week or more, and then goes abroad for a week. The practice manager told us that this was a regular arrangement.

We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday, Tuesday 8.45am to 5.15pm

Wednesday 8.45am to 6pm

Thursday 9.15am to 6.45pm

and Friday 8.45am to 4.30pm

Our key findings were:

• The practice appeared mostly clean and well maintained. We saw some areas were covered in dust, flooring was cracked in various places and rust had spread to the floor in the decontamination room. We saw a large hole in the wall in one surgery. Two of the wooden panels of the back gate were missing.
• The practice infection control procedures did not reflect published guidance.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were not all available as described in national guidance.
• The practice had minimal systems to help them manage risk.
• The practice had minimal safeguarding processes for safeguarding vulnerable adults and children. There was no policy for safeguarding of vulnerable adults.
• The provider did not undertake thorough staff recruitment procedures.
• The clinical staff provided patients’ care and treatment in line with current guidelines.
• Staff treated patients with dignity and respect and took some 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 leadership was not effective and a culture of continuous improvement within the practice was not evident.
• Staff felt involved and supported and worked well as a team. The practice manager required more support and time to perform their role efficiently.
• The practice asked staff and patients for feedback about the services they provided.
• The practice dealt with complaints positively and efficiently.
• The practice had suitable information governance arrangements.

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

• Ensure care and treatment is provided in a safe way to patients.
• 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.

Full details of the regulations the provider was not meeting are at the end of this report.

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

• Review the practice’s systems for monitoring referrals to ensure they are efficient.
• Review the practice’s security of patients’ record cards to ensure they are kept secure at all times.

We carried out an announced comprehensive inspection on 19 November 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 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 providing well-led care in accordance with the relevant regulations.

Background

The practice is owned by Dr Bamdad Mohri. The practice offers primary care dentistry to patients under the NHS.

The practice is open Monday, Tuesday and Thursday 9am to 5.15pm, Wednesday 9am to 6.30pm, and Friday 9am to 2pm.

There are two dentists, three dental nurses, a dental therapist, two receptionists and a practice manager.

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 patients about the service via 15 Care Quality Commission comment cards. All the comments were positive about the staff and the services provided. Comments included: were very friendly, excellent, and fantastic.

Our key findings were:

• There was an effective complaints system.
• Staff had received safeguarding training, knew how to recognise signs of abuse and how to report it.
• There were sufficient numbers of suitably qualified staff to meet the needs of patients.
• Staff had been trained to manage medical emergencies.
• Infection control procedures were in accordance with the published guidelines.
• Patient care and treatment was planned and delivered in line with evidence based guidelines and current regulations.
• Patients received clear explanations about their proposed treatment, costs, benefits and risks and were involved in making decisions about it.
• Patients were treated with dignity and respect and confidentiality was maintained.
• Patients could access routine treatment and urgent care when required.
• The practice was well-led, staff felt involved and supported and worked well as a team.
• The governance systems were effective.
• The practice sought feedback from staff and patients about the services they provided.

At the previous inspection in December 2014 we found care and treatment was not planned and delivered in a way to ensure people's safety and welfare; effective systems were not in place to regularly assess and monitor the quality of service that patients received, and accurate and appropriate records were not being maintained.

The provider sent us an action plan which had been completed following our inspection. This included the actions they were going to take to meet the regulations and the timescale within which these would be achieved.

We returned to the practice unannounced on 29 April 2015 to review whether the provider had made improvements. We found improvements had been made in these areas. We spoke with the practice manager, two dental nurses and two dental practitioners; one of whom was the practice owner. We also spoke with three patients after they had seen a dental practitioner that day.

On the day of our inspection, one of the two dental surgeries within the practice was in use.

Patients who used the service were given appropriate information regarding their care or treatment. We spoke with three patients in the waiting area within the practice after their appointments. Everybody we spoke with said they were satisfied with the information they had received at the practice. This included being given information to be able to make decisions about any treatment required. All of the patients we spoke with said they had no reason to complain.

The practice kept a supply of medicines to be used in the event of an emergency; for example if a patient needed to be resuscitated. These were checked regularly to ensure they remained safe to use.

The provider had effective systems in place to regularly assess and monitor the quality of service that patients received. This included checks on the quality of x-rays taken and feedback from patients received through a number of sources.

Patients were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.

The improvements made need to become embedded within the practice, to ensure that patients receive safe and appropriate care and treatment.

This was an unannounced, responsive inspection because we received anonymous information of concern that suggested a number of regulations were not being met by the provider. We used a specialist dental adviser to assist with our inspection.

On the day of our inspection, both dental surgeries within the practice were in use.

Patients who used the service were given appropriate information regarding their care or treatment. We spoke with four patients in the waiting area within the practice, both before and after their appointments. Everybody we spoke with said they were satisfied with the information they had received at the practice.

Patients said they were satisfied with the treatment they received at the practice. Nobody expressed any concerns about the treatment provided; however our findings did not always support this. We saw an example of a patient record where the dentist had understated by a substantial degree the amount of dental decay present in a patient. We saw another two examples of patient records which showed there was underscoring of gum disease. This meant that patients’ needs were not fully assessed in every case and their care and treatment could be compromised as a result.

We found patients were treated in a safe, clean environment and appropriate precautions were taken with regards to cleanliness and infection control.

Medicines were prescribed and given to patients appropriately. Records of any medicines prescribed were maintained. The practice kept a supply of medicines to be used in the event of an emergency; for example if a patient needed to be resuscitated.

The provider did not have effective systems in place to regularly assess and monitor the quality of service that patients received.

Patients were not protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not maintained.