We undertook a follow up focused inspection of Finest Dental in Leicester on 9 January 2019. 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 by a specialist dental adviser.

We undertook a comprehensive inspection of Finest Dental, Leicester on 21 August 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 regulation 17 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 Finest Dental Leicester on our website www.cqc.org.uk.

As part of this inspection we asked: Remove as appropriate:

• 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 improvement was required.

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 21 August 2018.

Background

Finest Dental Leicester is close to the city centre and provides private dental treatment to adults and children.

There is level entry into the practice, which is of benefit for people who use wheelchairs and those with pushchairs. There is pay and display car parking in the area around the practice and a bus stop outside the front door.

The dental team includes three dentists, one qualified dental nurse and one practice manager. The practice has one treatment room which is located on the ground floor with level access.

The practice is owned by an organisation and as a condition of registration must have a person registered with the Care Quality Commission as the registered manager. Registered managers 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 registered manager at the time of the inspection was one of the dentists.

The practice is open: Tuesday: 11am to 8pm, Wednesday: 9am to 6pm, Thursday: 11am to 8pm, Friday: 9am to 6pm and Saturday: 10am to 5pm. The practice is closed on Sunday and Monday.

Our key findings were:

• The practice had a system for receiving and acting on safety alerts from the Medicines and Healthcare products Regulatory Agency. When relevant this information was shared with all team members.

• The provider had made improvements in relation to the control and storage of substances hazardous to health identified by the Control of Substances Hazardous to Health Regulations 2002 (COSHH).

• The provider had reviewed their systems and processes for checking that medicines and emergency equipment were in date, and working correctly and had taken account of the guidelines issued by the Resuscitation Council (UK) and the General Dental Council.

• The provider had introduced systems for checking that dental materials in the treatment room were in date, and fit for purpose.

• The provider had the necessary documentation that demonstrated the X-ray equipment and particularly the cone beam computed tomography machine had been installed safely.

We carried out this announced inspection on 21 August 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

Finest Dental Leicester is close to the city centre and provides private dental treatment to adults and children.

There is level entry into the practice, which is of benefit for people who use wheelchairs and those with pushchairs. There is pay and display car parking in the area around the practice and a bus stop right outside the front door.

The dental team includes three dentists, one qualified dental nurse and one practice manager. The practice has one treatment room which is located on the ground floor with level access.

The practice is owned by an organisation and as a condition of registration must have a person registered with the Care Quality Commission as the registered manager. Registered managers 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 registered manager at the time of the inspection was one of the dentists.

On the day of inspection, we received feedback from 22 patients.

During the inspection we spoke with two dentists, one dental nurse and the practice manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open: Tuesday: 11am to 8pm, Wednesday: 9am to 6pm, Thursday: 11am to 8pm, Friday: 9am to 6pm and Saturday: 10am to 5pm. The practice is closed on Sunday and Monday.

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Our key findings were:

• The practice appeared clean and well maintained.
• The practice had infection control procedures which reflected published guidance.
• Staff knew how to deal with emergencies. Appropriate medicines and some life-saving equipment were available. Some resuscitation equipment was faulty and in need of replacement, and portable suction was not available.
• Some emergency medicines were passed their expiry date.
• Some dental materials in the treatment room were passed their use-by date.
• The practice did not have a system to receive safety alerts from the Medicines and Healthcare products Regulatory Agency.
• There were no risk assessments or manufacturer’s product safety sheets related to the Control of Substances Hazardous to Health Regulations 2002 (COSHH).
• The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• The practice had 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 care to protect their privacy and personal information.
• The practice’s consent policy did not contain all of the information to ensure staff were informed about all relevant aspects of patient consent in dentistry.
• The practice was providing preventive care and supporting patients to ensure better oral health.
• The critical examination documentation relating to the installation of the cone beam computed tomography machine was not available for inspection.
• The practice did not have an induction hearing loop to assist patients with hearing loss who used a hearing aid.
• The appointment system met patients’ needs.
• The practice had effective leadership and culture of continuous improvement.
• Staff felt involved and supported and worked well as a team.

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

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

Full details of the regulation/s the provider was/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 policies and procedures for obtaining patient consent to care and treatment to ensure they are following legislation, take into account relevant guidance, and staff follow them.

• Review its responsibilities to the needs of people with a disability, including those with hearing impairments and the requirements of the Equality Act 2010.

• Review the availability of an interpreter service for patients who do not speak English as their first language.