We undertook a focused inspection of Greenside Dental Care on 22 October 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 Greenside Dental Care on 23 July 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 in accordance with the relevant regulations 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 Greenside Dental Care on our website www.cqc.org.uk.

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.

As part of this inspection we asked:

• Is it well-led?

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 23 July 2018.

Background

Greenside Dental Care is in Cleckheaton and provides private treatment to adults and NHS treatment to children.

There is a small step to access the practice. Car parking spaces are available near the practice.

The dental team includes four dentists, five dental nurses, one dental hygienist, one dental hygiene therapist, one practice manager and a domestic operative. The practice has five 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 Greenside Dental Care is the practice manager.

During the inspection we spoke with 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 and Friday from 8:00am to 5:30pm

Tuesday from 8:00am to 7:00pm

Our key findings were:

• Improvements had been made to the overall governance arrangements.
• Pressure vessel inspections had been carried out on the autoclaves and compressors.
• Recommendations made in the routine test of the X-ray machine had been carried out.
• Recommendations made in the Legionella risk assessment had been completed.
• Prescription pads and antibiotics were stored securely, and appropriate logs maintained.
• Audits of X-rays and infection prevention and control had been carried out.

We carried out this announced inspection on 23 July 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

Greenside Dental Care is in Cleckheaton and provides private treatment to adults and NHS treatment to children.

There is a small step to access the practice. Car parking spaces are available near the practice.

The dental team includes four dentists, five dental nurses, one dental hygienist, one dental hygiene therapist, one practice manager and a domestic operative. The practice has five 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 Greenside Dental Care is the practice manager.

On the day of inspection, we collected 43 CQC comment cards filled in by patients.

During the inspection we spoke with one dentist, one dental nurse, one dental hygienist and therapist 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 and Friday from 8:00am to 5:30pm

Tuesday from 8:00am to 7:00pm

Our key findings were:

• The practice appeared clean and well maintained.
• The provider had infection control procedures which reflected published guidance. Improvements could be made to the process for storing re-usable dental equipment.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• The practice staff had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
• The provider had thorough staff recruitment procedures.
• 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 provider 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.
• Improvements could be made to the process for ensuring equipment is serviced according to manufacturer’s guidance and any recommendations are acted on.
• The process for managing risks associated with fire and Legionella could be improved.
• Improvements could be made to the process for the security of prescription only medicines and NHS prescription pads.
• The provider had suitable information governance arrangements.

We identified regulations 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 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 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. In particular, the storage of re-usable dental equipment.
• Review the security of the clinical waste bin.

After the inspection we telephoned four people that used the service. They told us they were satisfied with the care and treatment provided.

Their comments included: "The dentist is great", “I get really good care here” and “they are a great bunch of people, they are efficient and the staff are pleasant and nice”.

We found the provider had appropriate systems in place to ensure consent was gained before they proceeded with the examination or treatment.

We found the provider had taken steps which ensured the care and welfare of people who used the service. There were arrangements in place to deal with medical emergencies.

We found the provider operated in clean and tidy facilities and had suitable infection prevention and control protocols in place.

We saw evidence there was an appropriate system in place for listening to and acting on people’s comments and concerns.