We undertook a follow up focused inspection of Gentle Dental on 15 May 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 Gentle Dental on 17 October 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 Gentle Dental on our website www.cqc.org.uk.

As part of this inspection we asked:

• Is it safe?

• 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 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 17 October 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 found at our inspection on 17 October 2018.

Background

Gentle Dental is in Salisbury, Wiltshire and provides private treatment for adults and children.

Due to the nature of the premises wheelchair access is not possible. Car parking spaces are available near the practice.

The dental team includes the principal dentist, one associate dentist, one dental hygienist, one dental nurse, one trainee dental nurse, one practice manager and two receptionists. The practice has three treatment rooms.

The practice is owned by a company 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 Gentle Dental is the principal dentist.

During the inspection we spoke with the principal dentist and the dental hygienist who are the owners of the practice. We also spoke with the trainee dental nurse. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open: Monday, Wednesday, Thursday 8-5pm, Tuesday 8.30 -7pm and Friday 9am-5pm.

Our key findings were:

• The provider had established a robust recruitment procedure to ensure only fit and proper persons were employed.
• The practice had made significant improvements in relation to their infection control procedures.

• Staff knew how to deal with medical emergencies. Equipment and medicines to deal with medical emergencies were readily available with the exception of a self-inflating bag with reservoir (child).
• Improvements had been made in relation to the radiation protection file and the checks carried out on the X-ray equipment.
• The practice had implemented effective systems to help them manage risks to patients and staff.

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

• Review the practice’s protocols for ensuring that all clinical staff have adequate immunity for vaccine preventable infectious diseases.
• Review the practice's protocols and procedures for the use of X-ray equipment in compliance with The Ionising Radiations Regulations 2017 and Ionising Radiation (Medical Exposure) Regulations 2017. In particular the use of a rectangular collimator to reduce the dose of radiation.
• Review the practice’s infection control procedures and protocols taking into account the guidelines issued by the Department of Health in the Health Technical Memorandum 01-05: Decontamination in primary care dental practices, and having regard to The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance’. In particular the use of a thermometer to monitor the temperature of the water throughout the manual cleaning procedure.
• Review the practice’s arrangements for ensuring good governance and leadership are sustained in the longer term.

We carried out this announced inspection on 17 October 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 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 not providing well-led care in accordance with the relevant regulations.

Background

Gentle Dental is in Salisbury and provides private treatment to adults and children.

Due to the nature of the premises wheelchair access is not possible. Car parking spaces are available near the practice.

The dental team includes one dentist, one dental hygienist, one dental hygiene therapist, three trainee dental nurses, one practice manager and two receptionists. The practice has three treatment rooms.

The practice is owned by a company 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 Gentle Dental is the principal dentist.

On the day of inspection, we collected 15 CQC comment cards filled in by patients and obtained the views of nine other patients.

During the inspection we spoke with the dentist, two trainee dental nurses, the dental hygienist, the receptionists 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, Wednesday, Thursday 8-5pm, Tuesday 8.30 -7pm and Friday 9am-5pm.

Our key findings were:

• The practice appeared clean.
• The provider had infection control procedures which did not fully reflect published guidance. Improvements could be made to the decontamination process.
• Not all staff knew how to deal with emergencies. Not all equipment and medicines to deal with medical emergencies were available.
• The practice had some systems to help them manage risk to patients and staff. Recommended actions from Fire Safety and Legionella risk assessments had not been completed.
• The practice had safeguarding processes, not all staff had completed training for safeguarding vulnerable adults and children.
• 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 was providing preventive care and supporting patients to ensure better oral health.
• The appointment system met patients’ needs.
• Staff felt involved and supported and worked well as a team.
• The practice asked patients for feedback about the services they provided.
• The provider dealt with complaints positively and efficiently.
• The provider 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.
• 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.
• 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 practice's policy for the control and storage of substances hazardous to health identified by the Control of Substances Hazardous to Health Regulations 2002, to ensure risk assessments are undertaken and the products are stored securely.
• Review the current staffing arrangements to ensure all dental care professionals are adequately supported by a trained member of the dental team when treating patients in a dental setting taking into account the guidance issued by the General Dental Council. The practice should consider the need for a suitable risk assessment.
• Review the need and oversight to ensure gas and electrical safety certificates are undertaken as required.