We carried out a focused inspection of Gnosall Dental Practice on 14 March 2018.

The inspection was led by a CQC inspector who had access to telephone support from a dental clinical adviser.

We carried out the inspection to follow up concerns we originally identified during a comprehensive inspection at this practice on 5 September 2017 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 area 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 Gnosall Dental on our website www.cqc.org.uk.

We also reviewed the key questions of safe, effective and responsive as we had made recommendations for the provider relating to these key questions. 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 5 September 2017.

In response to concerns raised to the CQC we carried out this unannounced inspection on 5 September 2017 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

Gnosall Dental Practice is in Gnosall and provides NHS and private treatment to patients of all ages.

There are steps to gain access to the building therefore level access is not available for people who use wheelchairs and pushchairs. Car parking spaces, including those for patients with disabled badges, are available at the rear of the practice in the shopping centre car park.

The dental team includes one dentist, three dental nurses, one dental hygienist, a secretary and a receptionist. 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 did not collect any CQC comment cards as this inspection was unannounced. We spoke with four patients during the inspection. This information gave us a positive view of the practice.

During the inspection we spoke with the principal dentist, one dental nurse, the receptionist and the company secretary. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday 9am to 5pm, Tuesday and Wednesday 8.30am to 5.30pm, Thursday 9am to 5.30pm and Friday 9am to 12pm.

Our key findings were:

• The practice was clean and well maintained.
• Infection control procedures did not all reflect published guidance. For example the practice used bleach to clean work surfaces in treatment rooms and were not disposing of and changing household gloves used in decontamination processes at the required frequency.
• Staff knew how to deal with emergencies but basic life support and emergency medical training was overdue. We were told that this training was booked for September 2017. Not all of the recommended emergency medicines and life-saving equipment was available but this was purchased following this inspection.
• The practice’s systems to help them manage risk were not robust. For example the practice had not completed a fire or sharps risk assessment. The practice were not completing an assessment of any premises they visited when they undertook domiciliary visits and had not assessed the individual circumstances to determine which emergency medicines and equipment may be required on these visits.
• The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• The practice’s staff recruitment procedures did not ensure that all information as detailed in Schedule three of the Health and Social Care Act was available.
• 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 appointment system met patients’ needs.
• Staff at the practice told us that they felt involved and supported and worked well as a team.
• The practice asked patients for feedback about the services they provided.
• The practice’s complaints policies required updating to provide information to patients of the external bodies that patients are able to complain to if they are not satisfied with the outcome of the investigation completed at the practice.

We identified regulations the provider was not meeting. They must:

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

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 systems for the recording, investigating and reviewing accidents or significant events which would help to prevent further occurrences and, ensure that improvements are made as a result.
• Review the storage of dental care records to ensure they are stored securely.
• Review its complaint handling procedures and establish an accessible system for identifying, receiving, recording, handling and responding to complaints by service users.

• Review its responsibilities as regards the Control of Substances Hazardous to Health (COSHH) Regulations 2002 and ensure all documentation is up to date and staff understand how to minimise risks associated with the use and handling of these substances.
• Review staff awareness of Gillick competency and ensure all staff are aware of their responsibilities.

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

Our inspection was discussed and arranged with the staff at the practice one day in advance. This was to ensure that we had time to see and speak with staff working at the practice, as well as people registered with the practice.

During the inspection we spoke with the dentist, who was now the new owner of the practice, two dental nurses and one receptionist. We reviewed some dental records, staff files, written policies and procedures and quality audits. During the inspection we spoke to three people including a family. After our inspection visit, we spoke by telephone with two people who were registered with the practice.

People that used the practice told us that they received excellent care and treatment that was planned and met their needs. We saw that all consultations were recorded in patient files. The dentist discussed any changes in health needs which would need to be taken into account when planning treatments. General health and oral care advice was also given as part of the consultation.

People told us that the surgery was always clean and tidy and that they had never had any concerns about hygiene practices. Some people we spoke with had completed an annual questionnaire.

There were no outstanding complaints logged at the practice. People we spoke with knew how to complain should the need arise. We saw that there were arrangements in place to monitor the quality of care, so that patients received a consistent high standard of treatment.