We carried out an announced comprehensive inspection on 6 December 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

Haymans Green Dental Practice is located in a residential suburb close to the centre of Liverpool. The practice has five treatment rooms, three of which are on the ground floor. Reception, a waiting room and a consultation / recovery room are also situated on the ground floor. There are two further treatment rooms, a waiting room, and two consultation rooms on the first floor. Parking is available outside the practice and in nearby streets. The practice is accessible to patients with disabilities, mobility difficulties, and to wheelchair users. The provider has been providing services from this location since 2005.

There are patient toilet facilities on both floors which are accessible to patients with disabilities and mobility difficulties but not to wheelchair users.

The practice provides general dental treatment to patients on an NHS or privately funded basis. The opening times are Monday to Friday 8.00am to 5.00pm. The practice is staffed by two principal dentists, a practice administrator, three associate dentists, three dental therapists, nine dental nurses, four of whom are also receptionists, three treatment co-ordinators, and a receptionist.

A previous practice manager is currently registered as the registered manager, however this practice manager has not worked at the practice since 2012 and a new registered manager is not in place. A registered manager is a person who is registered with the Care Quality Commission to manage the service. 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.

We received feedback from 38 people during the inspection about the services provided. Patients commented that they found the practice excellent, and that staff were professional, friendly, and caring. They said that they were always given good and helpful explanations about dental treatment. Patients commented that the practice was clean and very comfortable.

Our key findings were:

• The practice had procedures in place to record and analyse significant events and incidents.
• The premises and equipment were clean, secure and well maintained.
• Staff followed current infection control guidelines for decontaminating instruments.
• Patients’ needs were assessed, and care and treatment were delivered, in accordance with current legislation, standards, and guidance.
• Patients received information about their care, proposed treatment, costs, benefits, and risks and were involved in making decisions about it.
• Patients were treated with kindness, dignity, and respect, and their confidentiality was maintained.
• The appointment system met the needs of patients, and emergency appointments were available.
• Services were planned and delivered to meet the needs of patients, and reasonable adjustments were made to enable patients to receive their care and treatment.
• The practice gathered the views of patients and took their views into account.
• Staff felt involved, and worked as a team.
• Staff had received safeguarding training, and knew the processes to follow to raise concerns; however no arrangements were in place for the most recently recruited member of staff to receive safeguarding training.
• Staff were trained annually to deal with medical emergencies, but no interim scenario-based training was carried out and no recent intermediate life support training had been carried out for staff involved in the provision of sedation. Most emergency medicines and equipment were available.
• The provider offered a sedation service at the practice and arrangements were in place to ensure this was delivered safely, however auditing of the procedures was not carried out to identify where improvements could be made.
• There were sufficient numbers of suitably qualified and skilled staff to meet the needs of patients but the provider did not carry out all pre-employment checks on all staff or check to ensure staff were up to date with their core training and registered with their professional body where relevant.
• Systems and processes were in place for the smooth running of the practice but they were not all operating effectively.

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

• Ensure staff involved in sedation procedures are trained appropriately to respond to medical emergencies, and medicines and equipment to manage medical emergencies are available having due regard to guidelines issued by the British National Formulary, the Resuscitation Council (UK), and the General Dental Council standards for the dental team.
• Ensure staff are up to date with their core training for their continuing professional development.
• Ensure the practice’s sharps handling procedures and protocols are in compliance with the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013, specifically in relation to the sharps risk assessment.
• Ensure the provider operates recruitment procedures effectively in carrying out employment checks for all staff and the required specified information in accordance with Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in respect of persons employed by the practice is held.
• Ensure the quality and safety of the service is assessed and monitored, for example, by carrying out regular audits of various aspects of the service, such as radiography and sedation. The practice should also ensure that audits have documented learning points, where relevant, and the resulting improvements can be demonstrated.
• Ensure that the practice is in compliance with its legal obligations under the Ionising Radiations Regulations 1999 and the Ionising Radiation (Medical Exposure) Regulations 2000.
• Ensure an effective system is established to assess, monitor and mitigate the various risks arising from undertaking of the regulated activities.
• Ensure the provider submits an application to appoint a Registered Manager.

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 practice’s infection control procedures and protocols having 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, specifically in relation to the routine testing of autoclaves.
• Review the practice’s arrangements for responding to patient safety alerts, recalls and rapid response reports issued by the Medicines and Healthcare products Regulatory Agency and through the Central Alerting System, as well as from other relevant bodies such as, Public Health England.
• Review the practice’s arrangements for communicating information about the quality and safety of services to people who use the service.

We spoke privately with three people who were attending the practice for check ups or treatment. All three people told us that they were "very pleased" and "more than satisfied" with all aspects of the service. They felt their dignity was maintained and their privacy protected. People using the practice told us they had been given copies of treatment options and the costs involved.

They told us that staff were "very friendly, courteous" and "professional". People told us that they felt reassured and at ease whilst receiving treatment at the dental practice and they had "no reasons for complaint".

Everyone commented on the cleanliness of the practice. They said they regularly saw staff making sure that the surgery was clean, tidy and hygienic. We observed that people received care and treatment in a clean environment with infection control measures in place to minimise the risk of infection.

When we looked at staff records we saw evidence that all staff had been professionally trained to the level their positions required and that they had completed training in other appropriate courses.

The provider had systems in place for gathering, recording and evaluating information about the quality and safety of care the service provides. People who used the service and their representatives were asked for their views about their care and treatment.

We carried out a follow up inspection on 20 July 2017 at Haymans Green Dental Practice.

On 6 December 2016 we undertook an announced comprehensive inspection of this service as part of our regulatory functions and during this inspection we found breaches of the legal requirements. A copy of the report from our last comprehensive inspection can be found by selecting the 'all reports' link for Haymans Green Dental Practice on our website at www.cqc.org.uk.

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

We undertook a follow up inspection of Haymans Green Dental Practice on 20 July 2017 to confirm they had followed their action plan and to confirm that improvements planned by the practice to meet legal requirements in the Health and Social Care Act 2008 and associated regulations had been made. We carried out this unannounced inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions.

We inspected the practice against one of the five questions we ask about services: is the service well-led? This is because the service was not meeting some of the legal requirements in relation to this question.

The inspection was led by a CQC inspector who was supported by a specialist dental adviser.

During the inspection we spoke to dentists, dental nurses, the receptionist and patient co-ordinators. We looked at practice policies, procedures and other records about how the service is managed, and reviewed the information sent to us by the practice.

Our findings were:

Are services

well-led

?

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

Background

Haymans Green Dental Practice is located in a residential area of Liverpool. The practice has five treatment rooms.

The provider has installed a ramp at the entrance to the practice to facilitate access for wheelchair users. There is parking available on nearby streets.

The practice provides general dental care and treatment for adults and children an NHS or private basis.

The opening times are:

Monday to Friday 8:00am to 5:00pm

The practice team consists of six dentists, a practice manager, two dental hygiene therapists, eight dental nurses, a receptionist and three patient co-ordinators.

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 Haymans Green Dental Practice was one of the principal dentists.

Our key findings were:

• The practice had arrangements in place to systems to review and monitor staff training and support staff to meet the requirements of their professional regulator.
• The practice’s systems to ensure sedation was provided safely were operating effectively.
• Improvements had been made to the recruitment procedures.
• The practice had quality assurance processes in place to encourage learning and continuous improvement.
• The practice had a sharps policy and risk assessment in place but not all staff were following this.

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

• Review the practice’s systems for assessing, monitoring and mitigating the various risks arising from the undertaking of the regulated activities, specifically in relation to used sharps and staff immunisation status.