We undertook a follow-up focused inspection of Green Lane Dental Surgery on 1 February 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 Green Lane Dental Surgery on 7 August 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 or well-led care and was in breach of regulations 12 and 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 Green Lane Dental Surgery on our website www.cqc.org.uk.

As part of this inspection we asked if care and treatment was:

• safe?

• 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 breach we found at our inspection on 7 August 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 breach we found at our inspection on 7 August 2018.

Background

Green Lane Dental Surgery is in Liverpool and provides NHS and private treatment to adults and children.

The approach to the practice is served by three large stone steps, with level access beyond this point for people who use wheelchairs and those with pushchairs. Car parking spaces are available immediately in front of the practice and in front of the community pharmacy next door to the practice.

The dental team includes one dentist, three dental nurses, one of whom is the practice manager, and two part-time dental hygienists. The practice has two treatment rooms. A implantologist visits the practice to provide care and treatment as required.

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.

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

The practice is open on Tuesday, Wednesday and Thursday from 8.45 am to 5.30pm; Monday from 8.45am to 7pm, and Friday from 8.45am to 2.00pm The practice closes for lunch Monday to Thursday from 1pm to 2pm.

Our key findings were:

The provider had taken sufficient steps to ensure that care and treatment was provided in a safe way to patients.

The provider had established effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

• The practice appeared clean and adequately maintained. Cleaning schedules were in place for all areas of the practice.

• All staff had received up to date infection control training; staff were aware of protocols for the flushing and management of dental unit water lines. Refresher training also covered the requirement for boxes used for the carrying of instruments between the surgery and decontamination room, to be scrubbed and decontaminated.

• Mops were stored correctly.

• Emergency medicines and equipment were available and ready for use, including emergency oxygen, sufficient to provide at least 30 minutes supply in an emergency.

• Weekly checks had been in place on the practice defibrillator. The practice had changed this to daily checks which were recorded.

• Staff were carrying out required tests on decontamination equipment, for example, the autoclave, to ensure required temperatures were being reached in the sterilising of dental instruments.

• Risk assessments were in place, in particular for Legionella management, fire risks and evacuation plans. Some items in the fire risk assessment required attention sooner rather than later. We discussed these with the principal dentist on the day of inspection, for example, the need to establish whether asbestos is present in some parts of the building.

• Copies of all checks required for recruitment of staff were available and held securely in staff files.

• Information governance overall had been improved. For example, the provider was now using an up-to-date audit tool for the audit of infection prevention and control.

• A log was in place to aid the secure and safe management of prescription pads. This enabled the practice to carry out prescribing audits.

The practice had made additional improvements. We saw that:

• Regular practice meetings were being held, where training needs for staff were being discussed.

• A training register was now in place allowing oversight of all staff training and any training requirements. All staff training was up to date.

• Appropriate products were being used for the cleaning of dental instruments.

• The provider had set a date for April 2019 when it would move to computerised record keeping.

We carried out this announced inspection on 7 August 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 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

Green Lane Dental Surgery is in Liverpool and provides NHS and private treatment to adults and children.

The approach to the practice is served by three large stone steps, with level access beyond this point for people who use wheelchairs and those with pushchairs. Car parking spaces are available immediately in front of the practice and in front of the community pharmacy next door to the practice.

The dental team includes one dentist, three dental nurses, one of whom is the practice manager, and two part time dental hygienists. The practice has two treatment rooms. An implantologist visits the practice to provide care and treatment as required.

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 collected 33 CQC comment cards filled in by patients and spoke with one other patient.

During the inspection we spoke with the principal dentist, the practice manager, two dental nurses, and one dental hygienist. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open on Tuesday, Wednesday and Thursday from 8.45 am to 5.30pm; Monday from 8.45am to 7pm, and Friday from 8.45am to 2.00pm The practice closes for lunch Monday to Thursday from 1pm to 2pm.

Our key findings were:

• The practice appeared clean and well maintained. We found some areas of the practice required more focussed cleaning.
• The practice staff had infection control procedures in place; we noted that not all staff had received up to date infection control training; staff did not have protocols to follow in the management of dental unit water lines.
• Staff knew how to deal with emergencies. Medicines and life-saving equipment were available. On inspection we found the medical oxygen cylinder to be out of date for pressure testing and that it was below the size recommended by the Resuscitation Council UK.
• The practice had some systems in place to help them manage risk; several of these had not been regularly reviewed for example, in relation to fire risks, personal evacuation plans and in respect of Legionella control.
• The practice staff could describe safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• The practice had staff recruitment procedures in place but copies of documents to support this were not in place for all staff. There was no overarching system in place to ensure checks were carried out on the indemnity cover of all clinical staff.
• The clinical staff provided patients’ care and treatment in line with current guidelines.
• Staff treated patients with dignity and respect.
• The practice was providing preventive care and supporting patients to ensure better oral health.
• The appointment system met patients’ needs.
• The practice had leadership and direction from the dentist.
• Staff felt involved and supported and worked well as a team.
• The practice asked staff and patients for feedback about the services they provided.
• The practice staff dealt with complaints positively and efficiently.
• The practice staff had some information governance arrangements in place but this required improvement.

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.

Full details of the regulations 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 practice's protocols for completion of dental care records taking into account the guidance provided by the Faculty of General Dental Practice.
• Review the content of meeting agendas to establish core subjects for discussion each month, for example significant events, staff training requirements and to share essential safety and clinical updates.
• Prioritise computerisation of the practice, to facilitate improved governance processes and management of documents.

We spoke with three people who were attending the dental practice for an appointment. They told us that they felt involved with their treatment and would know whom to approach if they had any concerns. They told us, "All staff are very good", "Very efficient, I have been coming here for years" and ” I feel that if I had any concerns they would go out of their way to make you happy”.

There were toothbrushes and other dental hygiene products available at the practice for patients to purchase if they wished and there was information for them to take away about oral hygiene.

The dental surgery we looked at on the day of the visit was of a suitable size, clean and well maintained. The room was fully equipped and we observed staff carrying out cleaning procedures in between each patient, thus minimising the risk of cross infection.

The practice had clear systems in place to maintain, monitor and improve the care and safety of people using the service.