We carried out a follow up inspection on 31 January 2017 of Haslam Park Dental Practice.

We had undertaken an announced comprehensive inspection of this service on 10 November 2016 as part of our regulatory functions and during this inspection we found breaches of the legal requirements.

After the comprehensive inspection, the practice wrote to us to say what they would do to meet the legal requirements in relation to the breach. This report only covers our findings in relation to those requirements.

We checked whether they had followed their action plan to confirm that they now met the legal requirements.

We reviewed the practice against oneof the five questions we ask about services: is the service well led?

A copy of the report from our last comprehensive inspection can be found by selecting the 'all reports' link for Haslam Park Dental Practice on our website at www.cqc.org.uk.

Our findings were:

Are services

well led

?

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

Background

Haslam Park Dental Practice is situated in Bolton, Lancashire. The practice offers mainly NHS dental treatments to patients of all ages and also offers private dental treatments. The services include preventative advice and treatment and routine restorative dental care.

The practice has two surgeries, a decontamination room, two waiting areas and a reception area. The reception area, one waiting room and one surgery are on the ground floor of the premises. The other waiting room and the second surgery are on the first floor of the premises. They have a portable ramp to access the premises and a stair lift.

There are two dentists and four dental nurses (two of whom are trainees).

The opening hours are Monday to Wednesday from 9-00am to 5-30pm, Thursday from 9-00am to 7-00pm and Friday from 9-00am to 5-00pm.

The practice owner is registered with the Care Quality Commission (CQC) as an individual. 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 adopted a comprehensive system of clinical governance.
• Risks associated with Legionella had been addressed.
• A system to ensure audits were carried out at regular intervals had been implemented.
• A training matrix had been implemented to ensure all staff were up to date with training.
• A cleaning schedule had been implemented.
• Infection control procedures and processes had been updated and implemented.
• A system was in place to ensure equipment was regularly serviced in line with manufacturer’s guidance.

We carried out an announced comprehensive inspection on 10 November 2016 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 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

Haslam Park Dental Practice is situated in Bolton, Lancashire. The practice offers mainly NHS dental treatments to patients of all ages and also offers private dental treatments. The services include preventative advice and treatment and routine restorative dental care.

The practice has two surgeries, a decontamination room, two waiting areas and a reception area. The reception area, one waiting room and one surgery are on the ground floor of the premises. The other waiting room and the second surgery are on the first floor of the premises. They have a portable ramp to access the premises and a stair lift.

There are two dentists and four dental nurses (two of whom are trainees).

The opening hours are Monday to Wednesday from 9-00am to 5-30pm, Thursday from 9-00am to 7-00pm and Friday from 9-00am to 5-00pm.

The practice owner is registered with the Care Quality Commission (CQC) as an individual. 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.

During the inspection we received feedback from 47 patients. The patients were positive about the care and treatment they received at the practice. Comments included staff were friendly, helpful, compassionate and empathetic. They also commented the environment was safe, clean and hygienic.

Our key findings were:

• Staff were qualified and had appropriate indemnity cover in place.
• Patients were involved in making decisions about their treatment and were given clear explanations about their proposed treatment including costs, benefits and risks.
• Dental care records showed treatment was planned in line with current best practice guidelines.
• Oral health advice and treatment were provided in-line with the ‘Delivering Better Oral Health’ toolkit (DBOH).
• We observed patients were treated with kindness and respect by staff.
• Staff ensured there was sufficient time to explain fully the care and treatment they were providing in a way patients understood.
• The practice had a complaints system in place which was readily available for patients.
• Patients were able to make routine and emergency appointments when needed.
• Staff told us they felt supported, appreciated and comfortable to raise concerns or make suggestions.
• One item of the medical emergency drug kit was out of date.
• Staff did not always wear appropriate personal protective equipment and there was no illuminated magnifying glass for checking instruments were free from debris prior to sterilisation.
• There were gaps in the servicing history of the stair lift and the compressor.
• Water temperatures were not checked each month in line with the Legionella risk assessment.
• Not all staff were up to date with their training for infection prevention and control and safeguarding.
• Environmental cleaning was not carried out in line with national guidance.
• One X-ray machine which was not used had not been adequately decommissioned.
• Audit was not embedded within the practice.

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

• Ensure an effective system is established to assess, monitor and mitigate the various risks arising from undertaking of the regulated activities.
• Ensure staff are up to date with their mandatory training and their Continuing Professional Development (CPD).
• Ensure the practice’s infection control procedures and protocols are suitable giving due regard to guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices and The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance’.
• Ensure infection control audits are undertaken at regular intervals and learning points are documented and shared with all relevant staff.
• Ensure audits of radiography are undertaken at regular intervals to help improve the quality of service. Practice should also ensure all audits have documented learning points and the resulting improvements can be demonstrated.
• Ensure systems are put in place for the proper and safe management of equipment.
• 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.

You can see full details of the regulations not being met at the end of this report.

There were areas where the provider could make improvements and should:

• Review the system for identifying and disposing of out-of-date stock.
• Review the protocols and procedures for use of X-ray equipment giving due regard to guidance notes on the Safe use of X-ray Equipment.

Haslam Park Dental practice had two dentists supported by four dental nurses. We found one ground floor and one first floor treatment rooms were available for use; these were clean, tidy and well maintained. A stair lift assisted people to reach the first floor treatment room.

We found that patients had access to appropriate information about the practice and treatment plans. We found information leaflets were available for patients in the reception area. The information gave details of treatment bands and costs for the NHS

We found patients gave informed consent at every visit and signed the relevant treatment plans to record this consent.

A patient we spoke with during the inspection told us: "I am very satisfied with the information I receive, I have been here years”.

Patient records were maintained in paper format. We sampled six patient records and found they were very comprehensive.

Records demonstrated that the patients understanding of the proposed treatment was confirmed. Detailed treatment records were maintained

We sampled staff training records and found that they evidenced that staff had received appropriate training to undertake their roles and responsibilities and also maintain their continued professional development (CPD).

We spoke with three staff who told us: "We get time for our CPD and have regular training".

We found during our visit we found the practice had systems in place to assess and monitor quality.

All the patients we asked said that they received clear information from the dentists. One patient said "It was all explained to me in terms I was capable of understanding" and another said "They explain everything". Patients told us the service was "Good", "Very good" and "Excellent". One patient said "Service is brilliant and all members of staff are friendly" and another said "No improvement is needed. The service is always brilliant".

Everyone who we asked said that the environment was clean. We were told that staff washed their hands frequently and wore protective equipment.

Comments on recently completed patient satisfaction questionnaires included "Really happy with the service given on every visit" and "Very friendly dentist".