We carried out an unannounced comprehensive inspection of this practice on 27 February 2017. Breaches of legal requirements were found. After the comprehensive inspection, the practice wrote to us to say what they would do to meet legal requirements in relation to providing safe care and treatment to patients, ensuring suitable staff were employed and implementing, effective governance systems.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Hanji Dental Group - 106 Northampton Road on our website at www.cqc.org.uk

Our findings were:

Are services safe?

We found that this practice was providing safe care in accordance with the relevant regulations.

Are services well-led?

We found that this practice was providing well-led care in accordance with the relevant regulations.

Background

Hanji Dental Group (Market Harborough Dental Practice) is a dental practice providing primarily NHS treatment with some private care for adults and children.

The practice is situated in a converted property on three floors and has four dental treatment rooms.

The practice is open from 8.30 am to 6 pm on Mondays and Wednesdays, from 8.30 am to 5 pm on Tuesdays and Thursdays, from 8.30 am to 1 pm on Fridays and 8.30 am to 2 pm on a Saturday.

The principal dentist is registered with the Care Quality Commission (CQC) as an individual. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the practice is run.

Our key findings were:

• The practice had infection control procedures which reflected published guidance.

• Staff knew how to deal with medical emergencies. Appropriate medicines and life-saving equipment were available.

• The practice had systems to help them manage risk.

• The practice had thorough staff recruitment procedures.

• The clinical staff provided patients’ care and treatment in line with current guidelines.

We carried out an unannounced comprehensive inspection on 27 February 2017 to ask the practice the following key questions; Are services safe, effective, caring, responsive and well-led?

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

Hanji Dental Group (Market Harborough Dental Practice) is a dental practice providing primarily NHS with some private care for adults and children. Where private treatment is provided this is on a fee per item basis. The practice is situated in a converted property on three levels and has four dental treatment rooms; two on the ground floor and two on the first floor. There is also an X-ray room and a reception and waiting area on the ground floor and a waiting room on the first floor. There were also other rooms used by the practice for office facilities and storage, some of which were on the second floor.

The practice is open from 8.30am to 6.00pm on Mondays and Wednesdays, from 8.30 to 5.00pm on Tuesday and Thursdays, from 8.30 to 1.00pm on Fridays and 8.30am to 2.00pm on Saturdays. The practice closes for lunch from 1.00pm to 2.00pm on Monday to Thursday.

The practice has three full time associate dentists and a part time orthodontist who was available every other Monday. They are supported by three dental nurses, three trainee dental nurses, three part time dental hygienists, three receptionists and a practice manager who was present on one or two occasions per week.

The practice are able to provide general dental services including endodontic (root canal) treatment, orthodontic treatment and some cosmetic dentistry.

The practice owner is registered with the Care Quality Commission as an individual. At the time of our inspection the practice manager had submitted an application to become the registered manager. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run.

We spoke with three patients on the day of our inspection. All feedback was positive with patients commenting favourably on the quality of care and service they received and the helpful nature of staff.

Our key findings were:

• There was not an effective system for reporting incidents as staff were not aware of how to report an incident and there were no mechanisms for investigation, discussion and learning in order to improve safety.
• The system to manage safety alerts was not effective.

• The practice was visibly clean but we found that not all infection control procedures were in line with the requirements of the ‘Health Technical Memorandum 01-05 (HTM 01-05): Decontamination in primary care dental practices’ published by the Department of Health.

• The practice had medicines and some equipment for use in a medical emergency which were in accordance with national guidelines. However there was no automated external defibrillator, airways or portable suction available. Glucagon was not stored in a temperature monitored fridge or in the drugs kit with an appopriately reduced expiry date. The medicines were stored inappropriately on the second floor away from clinical areas and other medicines, for example antibiotics, were not stored securely.
• During our inspection we were unable to ascertain if there were sufficient numbers of suitably qualified staff working at the practice to meet patients’ needs as a full staff list was not available, some staff files were not present and there was limited evidence relating to training and continued professional development (CPD). Staff appraisals had not been completed.

• The practice had suitable facilities. However evidence was not available to demonstrate that all equipment had been appropriately maintained.

• Not all risks had been assessed and where they had been not all identified actions had been implemented.

• Patients commented that they were pleased with the care they received and that staff were helpful, kind and caring.

We identified regulations that were not being met and the provider must:

• Ensure care and treatment is provided in a safe way for patients in accordance with the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. For example, this includes processes and procedures related to infection control, legionella, the management of substances hazardous to health, availability and storage of medicines and emergency equipment, the safe use of X-ray equipment and assurance that staff are appropriately qualified.

• Ensure systems and processes are operated effectively to assess and monitor the service and risks in accordance with the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. For example, this includes; the management of significant events, patient safety alerts assessing and mitigating all risks, having an effective audit system, security of prescriptions and patient records, and ensuring dental care records are maintained appropriately giving due regard to guidance provided by the Faculty of General Dental Practice and the National Institute for Health and Clinical Excellence.

• Ensure staff are suitably qualified, competent, and skilled and receive support, training, supervision and appraisal.

• Ensure the practice's recruitment policy and procedures are suitable and the recruitment arrangements are in line with Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 to ensure necessary employment checks are in place for all staff and the required specified information in respect of persons employed by the practice is held.

We spoke in private to four people using the services. They were all extremely pleased with the service they were receiving and only had the highest compliments for all the staff they came into contact during their visits. They all indicated that they felt fully involved in their treatment. They told us they always had available treatment options explained clearly for them.

The four people we spoke with said that the practice was always clean. Each person confirmed that the dentists and nurses always offer them glasses to protect their eyes, wear these themselves and that they always wear disposable gloves. People told us that they see staff take their gloves off and wash their hands and put clean gloves on. People also told us that after they had finished their treatment they saw that the nurse would start to clean parts of the treatment room before they left.