We carried out a focused inspection of Fishermead Dental Surgery on 22 August 2017.

The inspection was led by a CQC inspector who was supported by a specialist dental adviser.

We carried out the inspection to follow up concerns we originally identified during a comprehensive inspection at this practice on 11 October 2016 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions.

At a comprehensive inspection we always ask the following five questions to get to the heart of patients’ experiences of care and treatment:

• Is it safe?
• Is it effective?
• Is it caring?
• Is it responsive to people’s needs?
• Is it well-led?

When one or more of the five questions is 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.

At the previous comprehensive inspection we found the registered provider was providing safe, effective, caring and responsive care in accordance with relevant regulations. We judged the practice was not providing well-led care in accordance with 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 Fishermead Dental Surgery on our website www.cqc.org.uk.

We also reviewed the key question of safe as we had made recommendations for the provider relating to this key question. We noted that improvements had been made.

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 to put right the shortfalls and deal with the regulatory breach we found at our inspection on 11 October 2016.

We carried out an announced comprehensive inspection on 11 October 2016 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 not providing well-led care in accordance with the relevant regulations.

Background

Fishermead Dental Surgery is a general dental practice situated in the Fishermead area of Milton Keynes, Buckinghamshire. The practice offers treatment to adults and children funded by the NHS or privately.

The practice is staffed by three dentists (two of whom work part time), two qualified dental nurses, and a receptionist/ practice manager. One of the dentists offered dental implants to patients. This is where a metal post is surgically placed into the jaw bone to support a tooth or teeth. Following our inspection the practice informed us that the implant service is currently under review.

The practice has two treatment rooms and is all on the ground floor making wheelchair access possible. A ramp is available for use at the front door where a step would otherwise prevent access.

The principal dentist is registered with the Care Quality Commission (CQC) as an individual. Like registered providers, they are ‘registered persons’. 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 comments from 26 patients by way of comment cards available at the practice for the two weeks prior to our inspection.

Our key findings were:

• The practice was visibly clean and clutter free with the exception of the window blinds in the treatment rooms which were dirty and not easily cleanable. These were replaced following the inspection.

• A new patient NHS appointment could normally be secured within a week or two.

• Emergency patients would be seen where possible on the day they contacted the service.

• Infection control standards did not always meet those set out in the ‘Health Technical Memorandum 01-05 (HTM 01-05): Decontamination in primary care dental practices’ published by the Department of Health.

• Clinicians used nationally recognised guidance in the care and treatment of patients.

• The practice carried medicines for use in medical emergencies in line with national guidance. Recommended emergency equipment which was missing at the time of the inspection was purchased shortly after.
• There was appropriate equipment for staff to undertake their duties and equipment was well maintained.
• The practice did not have a system in place to report and monitor significant incidents, although they did have an accident book.

• Policies and protocols were available to aid the smooth running of the service, although the practice was not always working in accordance with their policies.

• The practice used tablet computers for patients to fill out medical history forms, and sign documents. These uploaded directly to the patient care record and meant that records were entirely computerised.

• The practice did not keep sufficient records of its prescription forms in line with current guidance.

• Infection control audits did not identify the areas of concern within the decontamination process that were apparent during the inspection. This indicated that the process of audit was not as robust as it needed to be.

We identified regulations that were not being met and the provider must

• Ensure effective systems and processes are established to assess and monitor the service against the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. For example, this includes management of infection control risks, effective systems to highlight risks and ensuring that practice policy is adhered to.

You can see full details of the regulations not being met at the end of this report.

There were areas where the provider could make improvements and should:

• Review the systems in place to record, investigate and learn from incidents that occur in the practice.

• Review the safety systems and processes in place at the practice to protect patients undergoing root canal treatment.

• Review the practice protocols regarding records of prescription forms with reference to the NHS guidance on security of prescription forms August 2013.

We spoke with people who use the service and they told us they thought the practice was brilliant. One person said "The staff are ever so kind and look after me" another person said "My dentist deserves a medal for looking after me, I was such a nervous patient and they have made me alot better".