We carried out an announced comprehensive inspection of this service on 8 September 2015 as part of our regulatory function where a breach of legal requirements was found. 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.

We followed up on our inspection of 8 September 2015 to check that the practice had implemented their plan and to confirm that they now met the legal requirements. We carried out a focused inspection on 13 October 2016 to check whether the practice had taken action to address a breach of Regulation 17(1), (2) (a) and (b) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

This report only covers our findings in relation to those requirements. You can read the report from our previous comprehensive inspection by selecting the ‘all reports’ link for Hillbrook Dental Health Centre 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.

Key findings

• Overall we found that sufficient action had been taken to address the shortfalls identified at our previous inspection and the provider was now compliant with the regulation.

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

• Review the security of prescription pads in the practice and ensure there are systems in place to monitor and track their use.
• Review the practice’s protocols for the use of rubber dam for root canal treatment giving due regard to guidelines issued by the British Endodontic Society.
• Review the practice’s infection control procedures and protocols 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.

We carried out an announced comprehensive inspection on 8 September 2015 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

Hillbrook Dental Health Centre offers mainly NHS treatment to patients of all ages but also offers private dental treatments. The services provided include predominantly routine restorative and preventative dental treatment but also domiciliary visits (to a local care home), implants, orthodontics and dental treatment under conscious sedation.

There is a waiting room and one treatment room on the ground floor and a further two treatment rooms on the first floor of the premises. The practice also has a decontamination room, a waiting room, a reception area and toilet facilities.

There are currently five dentists (one of whom is the principal dentist) and one dental therapist. There are also four receptionists and five dental nurses (two are trainees). One of the dental nurses also acts as the practice manager. The principal dentist is also in the process of recruiting another two dental nurses.

The opening hours are 9am to 5pm on Monday, Tuesday, Thursday and Friday. The practice is open from 9am to 7pm on Wednesday – this provides some flexibility for working age people and families with school children. Domiciliary visits were also carried out during these hours. However, during the inspection, we were informed that the principal dentist would be subsequently carrying out domiciliary visits during the practice’s lunch hour only.

The principal dentist is the registered manager. 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.

26 patients provided feedback about the practice. We looked at comment cards patients had completed prior to the inspection and we also spoke with patients on the day of the inspection. Overall the information from patients was very positive. Patients were positive about their experience and they commented that they were treated with care, respect and dignity.

Our key findings were:

• The practice had systems in place to record accidents and complaints.
• Staff had received safeguarding training but not all staff members were aware of how to proceed in the event of a safeguarding issue.
• Staff had been trained to handle emergencies and appropriate medicines and life-saving equipment was readily available. This was available at the practice but not at the domiciliary visits (although the practice changed their policy with immediate effect so that this equipment was available on domiciliary visits too).
• Infection control procedures were in place but improvements were needed. Further training was required as not all staff members were consistently following published guidance.
• Patient care and treatment was planned and delivered in line with evidence based guidelines, best practice and current legislation.
• Patients were treated with dignity and respect and confidentiality was maintained.
• The appointment system met the needs of patients.
• There was an effective complaints system.
• Staff felt involved and worked as a team.
• The practice sought feedback from patients about the services they provided.
• Governance systems were in place but improvements were required around their auditing processes.
• Patients who completed Care Quality Commission comment cards were pleased with the care and treatment they received and complimentary about the dentist and the practice team.
• Not all processes to assess, monitor and improve the quality and safety of the services were effective.

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

• Establish an effective system to assess, monitor and improve the quality and safety of the services provided in the carrying on of the regulated activity.
• Establish an effective system to assess, monitor and mitigate the risks relating to the health, safety and welfare of patients and others.

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:

• Consider further training for staff in safeguarding, whistleblowing and Legionella prevention.
• Review their infection control procedures for safer practice.
• Consistently follow their own recruitment policy by obtaining references for newly appointed staff.
• Have a robust process to monitor professional registration and medical indemnity of the clinical staff members.
• Review arrangements for conducting audits and learning from the results.

Our visit was discussed and arranged with the practice in advance. This was to ensure that we had time to see and speak to staff working at the practice, as well as people registered with the practice.

During the inspection we spoke with two dentists (one of whom was also the registered provider), three dental nurses, one receptionist and the practice manager and observed a consultation. After our inspection visit, we spoke by telephone with seven people who were registered with the practice to ask them about their experiences of the service.

The people we spoke with were complimentary about the service they had received. Their comments included, “Very good treatment”, “Can’t do enough for you, absolutely brilliant” and “He (the dentist) and his staff are very good.” People told us they were given the information they needed to be able to make an informed decision about their treatment.

Staff received a range of training so that they had up to date knowledge and skills in order to treat people safely when they attended the practice.

People told us that the practice was clean and tidy and we found that the provider had effective infection control procedures in place. This meant the risk of infection for people using the service was minimised.

There were systems in place that ensured people using the service were asked their views about the service so the provider could use the information to improve.