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 now met legal requirements.

The inspection was led by a CQC inspector.

Previously, we had undertaken a comprehensive inspection on 18 October 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 Hethersett Dental Practice 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 area where improvement was required.

As part of this inspection we asked:

• Is it well-led?

Background

Hethersett Dental Practice is a well-established practice which provides private treatment to adults and some NHS treatment to children. The dental team includes two dentists, two hygienists, three dental nurses, a receptionist and a practice manager. The practice has three treatment rooms.

The practice opens on Mondays to Thursdays from 8.40 am to 5.30 pm, and on Fridays from 9 am to 5 pm.

The practice has its own parking facilities, and there is on street parking nearby. Wheelchair access is available at the front of the property via a ramp, and there are ground floor treatment rooms.

The practice is owned by a company 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 the practice is the principal dentist.

On the day of inspection, we spoke the practice manager and reviewed a range of records about how the service is managed.

Our findings were:

The provider had made effective improvements in relation to the regulatory breach we found at our previous inspection and was now providing well-led care in accordance with the relevant regulations. These improvements must be sustained in the long-term.

We carried out this announced inspection on 18 October 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

Hethersett Dental Practice is a well-established practice which provides private treatment to adults and some NHS treatment to children. The dental team includes two dentists, two hygienists, three nurses, a receptionist and a practice manager. The practice has three treatment rooms.

The practice opens on Mondays to Thursdays from 8.40 am to 5.30 pm, and on Fridays from 9 am to 5 pm.

The practice has its own parking facilities, and there is on street parking nearby. Wheelchair access is available at the front of the property via a ramp, and there are ground floor treatment rooms.

The practice is owned by a company 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 the practice is the principal dentist.

On the day of inspection, we collected 29 CQC comment cards filled in by patients and spoke with two other patients. We spoke with one dentist, two dental nurses, one dental hygienist, one receptionist and the practice manager.

Our key findings were:

• Information from completed Care Quality Commission comment cards gave us a positive picture of a caring and professional service.
• The practice appeared clean and well maintained.
• Infection control procedures reflected published guidance.
• The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
• Patients’ needs were assessed and care was planned and delivered in line with current best practice guidance from the National Institute for Health and Care Excellence (NICE) and other published guidance.
• Patients received their care and treatment from well supported staff, who enjoyed their work.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted upon.
• Medicines were not managed in a safe way.
• Audit systems within the practice were limited
• Clinicians were not following national guidance in relation to sharps’ management and the use of rubber dams.

We identified regulations the provider was not meeting. They must:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care

Full details of the regulation/s the provider was/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 responsibilities to meet the needs of people with a disability, including those with hearing difficulties and the requirements of the Equality Act 2010.

We spoke with staff and with two people who used the service. We also observed another person having a dental check-up, with their permission. Two members of staff shared the practice manager's role, both of them were present during our inspection.

The people we spoke with told us that practice staff always sought their consent to treatment. One person said that they were given the opportunity to discuss treatment options and that staff would give further explanations if requested. This showed that people were able to give valid consent to their treatment.

We saw evidence that the practice regularly reviewed its services to ensure that it was meeting patients' needs. The people we spoke with were positive about their experience of the practice. One person told us “The dentist is very thorough.” The practice was situated in a single-storey building with an adjacent car park. This meant that the practice and all public areas within it were accessible to people who used wheelchairs.

The practice was clean and well-decorated, with a separate decontamination room equipped with two sinks, a magnifier and two autoclaves. One person said that the practice was "...always clean." We watched a dental nurse carrying out sterilisation according to the practice’s procedure. We saw evidence that the practice supported staff in maintaining their skills and knowledge. We noted that the practice had reviewed and responded appropriately to any concerns that people may have identified.