We carried out this announced inspection on 1 May 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 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

Gaskell Avenue Dental Practice is close to the centre of Knutsford and provides NHS and private dental care and treatment for adults and children.

There is level access to facilitate entrance to the practice for people who use wheelchairs and for pushchairs. Car parking is available outside the practice.

The dental team includes three principal dentists, an associate dentist, a visiting specialist dentist, seven dental nurses, two of whom carry out reception duties, and one of whom carries out practice administration duties, two dental hygienists, and two receptionists. The practice has six treatment rooms.

The practice is owned by a partnership 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 Gaskell Avenue Dental Practice was one of the principal dentists.

We received feedback from 19 people during the inspection about the services provided. The feedback provided was positive about the practice.

During the inspection we spoke to four dentists, dental nurses, a dental hygienist, receptionists and the administration manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday 9.00am to 5.30pm

Tuesday 9.00am to 8.00pm

Wednesday 8.00am to 4.30pm

Thursday 8.30am to 4.30pm

Friday 9.00am to 5.30pm

Our key findings were:

• The practice was clean and well maintained.
• The practice had infection control procedures in place which reflected published guidance.
• Staff knew how to deal with medical emergencies. Most of the recommended medical emergency medicines and equipment were available, with the exception of resuscitation bags and masks.
• Staff knew their responsibilities for safeguarding adults and children.
• The provider had staff recruitment procedures in place. We saw that recruitment checks were carried out for newly employed staff but ongoing monitoring of existing staff was not in place.
• The practice offered domiciliary care in some circumstances. We found that they did not always take into account the current guidelines.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• The dental team provided preventive care and supported patients to achieve better oral health.
• The appointment system took account of patients’ needs.
• The provider had a procedure in place for dealing with complaints.
• The practice had a leadership and management structure. Responsibilities were shared between the leaders but were not clearly understood by staff.
• Staff felt involved and supported and worked well as a team. The provider used a wide skill mix to provide care and treatment for patients.
• The practice asked patients and staff for feedback about the services they provided.
• The provider had governance arrangements in place. Some of these were not specific to the practice’s circumstances.
• The provider had systems in place to manage risk. A number of these were not operating effectively.

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 persons employed for the purpose of carrying on a regulated activity are of good character, have the qualifications, competence, skills and experience which are necessary for the work to be performed by them, and are able by reason of their health, after reasonable adjustments are made, of properly performing tasks which are intrinsic to the work for which they are employed.
• Ensure specified information is available regarding each person 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 security of NHS prescription pads in the practice and ensure there are systems in place to track and monitor their use, including those in daily use in the practice.
• Review the availability of an interpreter service for patients who may require one.
• Register the use of dental X-ray equipment with the Health and Safety Executive in compliance with the Ionising Radiations Regulations 2017.

We spoke with five patients who were visiting the practice during our inspection and they all told us they were happy with the service provided. One patient told us: “The staff here are all cheerful, it’s a well run, bright and helpful surgery.” Another patient commented that they travelled to the practice as they had every confidence in their dentist and found all the staff to be, “Professional and approachable.”

Patients told us that the dental practice was well presented and that the surgeries were always very clean and tidy when they attended.

One of the patients who had attended the practice told us they had received a dental treatment. They told us they were consulted and informed about the treatment options, had consented to the treatment provided and were given appropriate after care advice following the treatment. They were very happy with their dentist and the practice and told us they found the staff to be professional and suitably skilled to deliver the treatments that they required.

We found that the majority of staff had worked for the practice for a number of years and the staff records we reviewed reflected this. The provider was aware that since their registration with the Care Quality Commission new staff were required to have all the appropriate pre employment checks undertaken prior to staff providing a service and that their staff personnel records should contain evidence of the completed recruitment checks.

We undertook a follow-up focused inspection of Gaskell Avenue Dental Practice on 23 August 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 by a specialist dental adviser.

We undertook a comprehensive inspection of Gaskell Avenue Dental Practice on 1 May 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 safe and well-led care, and was in breach of Regulations 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 Gaskell Avenue Dental Practice on our website www.cqc.org.uk.

When one or more of the five questions are not met we require the provider to make improvements and send us an action plan. We then inspect again after a reasonable interval, focusing on the areas where improvements were necessary.

As part of this inspection we asked:

• Is it safe?

• Is it well-led?

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 breach we identified at our comprehensive inspection on 1 May 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 breaches we identified at our comprehensive inspection on 1 May 2018.

Background

Gaskell Avenue Dental Practice is close to the centre of Knutsford and provides NHS and private treatment for adults and children.

There is level access to facilitate entrance to the practice for people who use wheelchairs and for pushchairs. Car parking is available outside the practice.

The dental team includes three principal dentists, an associate dentist, a visiting specialist dentist, seven dental nurses, two of whom carry out reception duties, and one of whom carries out practice administration duties, two dental hygienists, and two receptionists. The practice has six treatment rooms.

The practice is owned by a partnership 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 Gaskell Avenue Dental Practice was one of the principal dentists.

During the inspection we spoke with one of the principal dentists and two receptionists. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday 9.00am to 5.30pm

Tuesday 9.00am to 8.00pm

Wednesday 8.00am to 4.30pm

Thursday 8.30am to 4.30pm

Friday 9.00am to 5.30pm

Our key findings were:

• The provider had improved their systems for managing risk.

• The child safeguarding policy was now customised to the practice’s specific circumstances.

• The provider had implemented robust staff recruitment procedures.

• The practice had improved the leadership and management structure and had introduced a culture of continuous improvement.

• Staff felt involved and supported, and worked well as a team.