We undertook a focused inspection of Fence Houses Dental Practice on 13 December 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 led by a CQC inspector who was supported remotely by a specialist dental adviser.

We undertook a comprehensive inspection of Fence Houses Dental Practice on 4 September 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 and was in breach of regulations 9, 12, 17 and 19 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 Fence Houses Dental Practice on our website www.cqc.org.uk.

As part of this inspection we asked:

• Is it safe?

• Is it effective?

• Is it well-led?

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 areas where improvements were required.

Our findings were:

Are services safe?

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

The provider had made improvements in relation to the regulatory breaches we found at our inspection on 4 September 2018.

Are services effective?

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

The provider had made improvements in relation to the regulatory breaches we found at our inspection on 4 September 2018.

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 4 September 2018.

Background

Fence Houses Dental Practice is in Houghton Le Spring and provides NHS and private treatment to adults and children.

There is a small step at the entrance to the practice. Staff are available to help people who use wheelchairs and those with pushchairs if assistance is needed into the practice. Car parking spaces are available near the practice.

The dental team includes three dentists (including the principal dentist), four dental nurses and a receptionist. One of the dental nurses is also the practice manager. 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 the practice manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday-Friday 9am to 5pm

Saturday 9am to 1pm.

Our key findings were:

• The provider had infection control procedures which reflected published guidance.
• The practice had effective leadership.
• The provider had improved their staff recruitment procedures.
• Training of staff was monitored efficiently.
• Policies were re-written and updated where applicable.
• Risk assessments had been reviewed and recommended actions were implemented.
• Referrals and prescriptions were monitored efficiently.
• Dental records were audited by the principal dentist to ensure treatment was reflective of national guidance.
• The practice had closed-circuit television (CCTV) on the premises; a policy had been created. There was no privacy impact statement in place.

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

• Review the practice's protocols for patient assessments and ensure they are in compliance with current legislation and take into account relevant nationally recognised evidence-based guidance. In particular, for undertaking X-rays and monitoring of gum health e.g. using the basic periodontal examination (BPE) index.

We carried out this announced inspection on 4 September 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 not providing safe care in accordance with the relevant regulations.

Are services effective?

We found that this practice was not 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

Fence Houses Dental Practice is in Houghton Le Spring and provides NHS and private treatment to adults and children.

There is a small step at the entrance to the practice. Staff are available to help people who use wheelchairs and those with pushchairs if assistance is needed into the practice. Car parking spaces are available near the practice.

The dental team includes three dentists (including the principal dentist), four dental nurses and a receptionist. One of the dental nurses is also the practice manager. 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.

On the day of inspection, we collected 32 CQC comment cards filled in by patients.

During the inspection we spoke with three dentists, four dental nurses and the receptionist. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday-Friday 9am to 5pm

Saturday 9am to 1pm.

Our key findings were:

• The practice appeared clean and well maintained.
• The provider had infection control procedures which reflected published guidance.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• The practice had some systems to help them manage risks.
• The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• The practice had staff recruitment procedures. These required reviewing.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information. The practice had closed-circuit television on the premises; there was no policy or privacy impact statement in place.
• The appointment system met patients’ needs.
• The practice had leadership and a culture of continuous improvement.
• 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 dealt with complaints positively and efficiently.
• The practice had suitable information governance arrangements.

We identified regulations the provider was not complying with. They must:

• Ensure care and treatment is provided in a safe way to patients.
• Ensure the care and treatment of patients is appropriate, meets their needs and reflects their preferences.
• 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.

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

• Review the practice’s protocols for the use of closed circuit television cameras taking into account the guidelines published by the Information Commissioner's Office.

We spoke with two people who used the service. One of the people we spoke with was seeking emergency dental treatment for treatment of a tooth abscess. He told us he was pleased with the prompt treatment he had received and was grateful he had been seen so quickly even though he had not booked for an appointment. People we spoke with who used the service were very complementary of it and the dentists and nurses who worked at the practice. One person told us, “I have never heard any adverse comments about this surgery”. Another person told us, “Considering my initial fear of dentists when I was in my teens, I am now very confident coming here”. “They make you feel comfortable and they are very re-assuring”. One person told us, “I have never felt so much at ease when I am here, I can only say they are very good”. People told us that their appointments were convenient to them and they had no problems changing their appointments if their circumstances changed. People described the service as “very good”. People also told us that during their treatment procedures, the dentist took their time to explain things to them and also explained the treatment options open to them.