We carried out an announced responsive follow up inspection on 20 February 2017 to ask the practice the following key questions; Are services well-led?

We had undertaken an announced comprehensive inspection of this service on 3 August 2016 as part of our regulatory functions where a breach of legal requirements were found.

IDH (Integrated Dental Holdings) is a national company which operates over 600 dental practices across the United Kingdom recently re-branded as ‘My Dentist’. The Kilkenny House practice provides both NHS dental treatment to adults and children and private dental treatment to and adults.

The practice is situated in the centre of Taunton town. The practice has eight potential dental treatment rooms six of which are currently in use, two decontamination rooms for the cleaning, sterilising and packing of dental instruments, a reception, two waiting areas, two staff rooms and a manager’s office. Dental services are provided on the ground and first floor. The main entrance to the practice is accessible by external steps and ramp access.

The practice is open Monday, Wednesday & Friday 8am – 5pm

Tuesdays and Thursdays 8am – 8pm, every other Saturday from 9am – 2pm. It is closed on Sunday.

IDH Kilkenny House has five dentists, a visiting implantoligist, two part time dental hygienists, six dental nurses one of whom is qualified and five are trainee dental nurses. The practice manager and clinical team are supported by three receptionists. The practice had a 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.

Before the inspection we reviewed the action plan the provider and registered manger had sent us.

Our key findings were:

• The practice was clean and well maintained.
• Infection control procedures were robust and the practice followed published guidance.
• Staff had been trained to handle emergencies and appropriate medicines and life-saving equipment were readily available in accordance with current guidelines.
• The practice had systems in place to manage risks.
• Staff understood and received safeguarding training and knew how to recognise signs of abuse and how to report it.
• Safe recruitment of staff was in place.
• The appointment system met patients’ needs.
• The practice was well-led and staff felt involved and supported and worked well as a team.
• The practice sought feedback from staff and patients about the services they provided.
• Complaints were responded to in an efficient and responsive manner.

We carried out a comprehensive inspection of IDH Kilkenny House Taunton on 3 August 2016.

IDH (Integrated Dental Holdings) is a national company which operates over 600 dental practices across the United Kingdom recently re-branded as ‘My Dentist’. The Kilkenny House practice provides both NHS dental treatment to adults and children and private dental treatment to and adults.

The practice is situated in the centre of Taunton town. The practice has eight potential dental treatment rooms six of which are currently in use, two decontamination rooms for the cleaning, sterilising and packing of dental instruments, a reception, two waiting areas, two staff rooms and a manager’s office. Dental services are provided on the ground and first floor. The main entrance to the practice is accessible by external steps and permanent disability ramp.

The practice is open Monday ,Tuesday, Wednesday, Thursday 08:00-20.00 Friday 08:00-17:00, Saturday 09:00 - 15:30 Sunday closed.

IDH Kilkenny House has six dentists, a visiting implantologist, two part time dental hygienists, three dental nurses (two of whom are trainees).The practice manager and clinical team are supported by three receptionists. The practice had a 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.

Before the inspection we sent CQC comments cards to the practice for patients to complete to tell us about their experience of the practice. We collected 12 completed cards. These provided a positive view of the service the practice provided. Patients commented staff were professional, caring, friendly and polite. Patients wrote they were listened to and staff made every effort to make suitable appointments. Patients also commented they felt safe and observed the practice to be clean and hygienic. During the inspection we spoke with three patients who were highly satisfied with the treatment and support they received at the practice.

Our key findings were:

• There were comprehensive policies and procedures at the practice; however we found that some were out of date which included the COSSH file.
• The practice carried out oral health assessments and planned treatment in line with current guidance, for example from the Faculty of General Dental Practice (FGDP). Patient dental care records were detailed and showed on-going monitoring of patients oral health.
• The practice had an efficient appointment system in place to respond to patient’s needs. Patients reported good access to the practice with emergency appointments available within 24 hours. There were clear instructions for patients regarding out of hours care.

• There were some systems to check equipment had been serviced regularly, including the compressor, autoclaves, fire extinguishers, oxygen cylinder and the X-ray equipment. However the systems were not always managed appropriately to ensure equipment checks had been completed within the necessary timeframes.

• The practice had the equipment and medicines they would need in the event of a medical emergency and staff had appropriate training.

• The practice took into account patient feedback, comments and complaints.

• The practice was visibly clean but parts were not well maintained such as the upstairs waiting room which had plaster defects evident and there was a badly watermarked ceiling in a downstairs surgery.

• Patients were highly satisfied with the treatment they received and complimentary about staff at the practice.
• Patients with mobility difficulties were able to access the practice. The practice had carried out a Disability Discrimination Act 1995 audit (DDA). The Disability Discrimination Act 1995 applies to all public and private organisations and businesses. This law ensures disabled people have the legal right to be treated equally to able bodied persons. Therefore all service providers have to ensure their service is accessible to people with disabilities.
• Staff were not always supported to maintain their continuing professional development. Not all staff had undertaken training appropriate to their roles;
• There were limited systems in place to learn and improve from incidents or healthcare alerts. The practice manager was not fully supported for example requests for maintenance at the practice had not been acted upon.
• Appropriate recruitment processes and checks were not always undertaken.

• We observed and were told the practice had a staffing shortfall in particular in relation to the dental nursing team. There was only one trained dental nurse in the practice on the day of inspection. Two dentists were working with trainee nurses who had not yet commenced training and one dentist was supported by an agency nurse.

• There was evidence of audits being undertaken at the practice to monitor and the quality of the service. However they were not always analysed, action plans were not complete and learning was not shared across the practice. There was no clear programme for re-audit.

• The dental practice had some clinical governance and risk management processes in place; however they were not wholly effective and lacked some attention to detail to ensure compliance with the relevant regulations.

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 in a timely way.
• Ensure the training, learning and development needs of staff members are reviewed at appropriate intervals and an effective process is established for the on-going assessment and supervision of all staff employed.
• Ensure staff are up to date with their mandatory training and their Continuing Professional Development (CPD) both regular and visiting staff.
• 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 audits of various aspects of the service, such as radiography and infection control are undertaken at regular intervals to help improve the quality of service. The practice should also ensure all audits have documented learning points which are shared with all staff and the resulting improvements can be demonstrated.
• Ensure all staff undertaken relevant training, to an appropriate level, in the safeguarding of children and vulnerable adults.

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 systems for the recording, investigating and reviewing of incidents or significant events with a view to preventing further occurrences and, ensuring improvements are made as a result.

• Review the practice responsibilities with regard to the Control of Substance Hazardous to Health (COSHH) Regulations 2002 and, ensure all documentation is up to date and staff understand how to minimise risks associated with the use and handling of these substances.

• Review the storage of products identified under Control of Substances Hazardous to Health (COSHH) 2002 Regulations to ensure they are stored securely.

• Review the storage of dental care records to ensure they are stored securely especially in relation to past records waiting to be archived.