During our announced comprehensive inspection of this practice on 2 February 2016, we found breaches of legal requirements in relation to the Health and Social Care Act 2008. Following this inspection, the practice wrote to us to say what they would do to meet legal requirements in relation to Regulation 12-Safe Care and Treatment, and regulation 17- Good Governance.

We undertook this focused inspection to check that the provider had followed their improvement plan and to confirm that they now met legal requirements. This report only covers our findings in relation to this requirement. You can read the report from our previous comprehensive inspection, by selecting the 'all reports' link for Cambridge Dental Hub at www.cqc.org.uk

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.

Key findings

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

We carried out an announced comprehensive inspection on 02 February 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 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

Hurst Park Dental Practice provides mostly private dental treatment to children and adults. In addition to general dentistry, the practice also provides a range of cosmetic dental procedures, dental implants, minor oral surgery and endodontics.

The practice employs 5 dentists and a dental hygienist. They are supported by a practice manager, seven dental nurses, and a receptionist. The practice is based in a converted GP surgery and has five treatment rooms, a decontamination room and a large staff room. Its opening hours are from 9am to 5pm on Mondays, Wednesdays and Thursdays; from 8am to 5pm on a Tuesday; and from 8am to 2pm on a Friday. There are some appointments available on a Saturday by arrangement with the individual dentist.

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.

We received feedback from 14 patients about the service. They told us that appointments were easy to book, that treatment options were explained well to them, and that staff treated them respectfully.

Our key findings were:

• The practice had some systems in place to help ensure patient safety. These included responding to medical emergencies and maintaining equipment.

• Patients’ care and treatment was planned and delivered in line with evidence based guidelines, best practice and current legislation

• Staff had the skills, knowledge and experience to deliver effective care and treatment

• Patients received clear explanations about their proposed treatment and were actively involved in making decisions about it. They were treated in a way that they liked by staff.

• Appointments were easy to book and emergency slots were available each day for patients requiring urgent treatment.

• The practice sought feedback from patients and used it to improve the service provided.

• Staff had a good understating of the Mental Capacity Act and the importance of gaining patients’ consent to their treatment.

• The practice did not have a structured plan in place to audit quality and safety beyond the mandatory audit for radiography.

• The practice did not undertake appropriate pre-employment checks for staff.

• Staff did not receive regular support and appraisal of their working practices.

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

• Ensure there are robust processes for reporting, recording, acting on and monitoring significant events, incidents and near misses.
• Ensure that all practice risk assessments are updated and accurately reflect potential hazards to both patients and staff.

• Ensure that all staff receive regular appraisal and supervision of their performance

• 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.

• Ensure that regular professional registration checks for dentist are undertaken to check they are still suitable to practice.

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

• Review safeguarding training to ensure all staff receive it an appropriate level.

• Review and update procedures, guidance and risk assessments regularly.

• Monitor water temperatures as recommended in the practice’s Legionella risk assessment.

• Review signage in the practice to ensure it identifies the location of emergency medical equipment, fire exits and the X-ray machines.

• Review infection control procedures in all areas of the premises.

• Review decontamination procedures 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 Provide practice information in appropriate languages and formats.

• Implement a system to ensure that all patient referrals are monitored.

• Undertake audits of various aspects of the service, such as dental care records at regular intervals to help improve the quality of service. All audits should have documented learning points and the resulting improvements can be demonstrated.

• Display dentists’ GDC registration numbers in accordance with current guidance so that patients are aware of them.

• Display NHS fee prices in accordance with current guidance so that patients are aware of them.

• Display out of hours information on the practice’s front door so that patients are aware of them.

Advertise the practice’s complaints procedure more widely so that patients know how to raise a concern.

People told us that they had been treated with respect at all times by the staff and by the different dentists employed by the practice. They said they had been kept fully informed about all aspects of their treatment and explained that they had made choices and had frequently been consulted about how their treatment was being provided. People confirmed they had been asked about their general health and whether they were taking medication at each appointment.

One young person said, “I like coming here. The dentist explains everything to me." Another person said, “I have seen the improvements and the changes the dentist has made. I have been attending this practice for quite a few years and would recommend it. They are really excellent."