We undertook a focused inspection of Graham Wilding Poulton le Fylde on 11 March 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 Graham Wilding Poulton le Fylde on 12 September 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 Graham Wildings practice in Poulton le Fylde on our website www.cqc.org.uk.

As part of this inspection we asked:

• 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 September 2018.

Background

The Graham Wilding’s practice is in Poulton le Fylde and provides private dental treatments to adults.

There are two members of staff working at the practice: the principal dentist and one dental nurse. The staff team has remained constant for a very long time. The practice has one treatment room on the first floor of the premises.

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 Graham Wilding Poulton le Fylde is the principal dentist.

The practice is open:

Monday, Tuesday and Thursday 8am -4pm.

Our key findings were:

• Overall governance of fire safety procedures and electrical safety had improved.
• The medical emergency medicines and equipment reflected nationally recognised guidance and a robust checking system was now in place.
• Dental care records had improved and had regard for the Faculty of General Dental Practice guidance regarding clinical examinations and record keeping.
• The practice's protocols and procedures for the use of X-ray equipment had been reviewed considering the guidance notes for dental practitioners on the safe use of X-ray equipment.

• Protocols regarding the prescribing of antibiotic medicines had been introduced considering the guidance provided by the faculty of general dental practice.
• Audits of various aspects of the service, such as radiography and patients’ records were completed to improve the quality of service.

We carried out this announced inspection on 12 September 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

Graham Wildings practice is in Poulton le Fylde and provides private dental cosmetic treatments to adults.

There is level access to the reception for people who use wheelchairs and those with pushchairs.

There are two members of staff working at the practice: the principal dentist and one dental nurse. The staff team has remained constant for a very long time. The practice has one treatment room on the first floor of the premises.

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 Graham Wilding Poulton le Fylde is the principal dentist.

On the day of inspection, we collected five CQC comment cards filled in by patients. During the inspection we spoke with the principal dentist and the dental nurse. We looked at practice policies and procedures, and other records about how the service is managed.

The practice is open:

Monday, Tuesday and Thursday 8.00am – mid-day and 1.00pm – 4.00pm.

Our key findings were:

• The practice appeared clean and well maintained.
• The provider had infection control procedures which reflected published guidance.
• Staff knew how to deal with emergencies. Not all appropriate medicines and life-saving equipment were available.
• The practice had systems to help them manage risk to patients and staff.
• The practice staff had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
• The provider had staff recruitment procedures.
• The clinical staff did not provide patients’ care and treatment in line with current guidelines and the dental care records lacked information.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• The provider was not 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 limited information governance arrangements.

We identified a regulation 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 the provider is not meeting are at the end of this report.

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

• Review the procedure for the checking and recording of the fire alarm system, emergency lighting and firefighting equipment.
• Review the fixed electrical wiring within the premises. A safety check needs to be completed by a competent person.
• Introduce protocols regarding the prescribing of antibiotic medicines taking into account the guidance provided by the Faculty of General Dental Practice.

During the inspection we spoke with three people (patients) who used the service. They told us they were very happy with the care and treatment they received. One person told us, “They are very approachable. I am always asked if I am happy with the treatment”.

Another person we spoke with made positive comments about their care and treatment and told us, "I came as a nervous patient and Graham did everything in stages. At any point he would stop. He spent a lot of time with me. He was brilliant in every way".

A third person we spoke with told us,” They are always helpful, I never feel rushed”.