We carried out a follow- up unannounced inspection at Inglemire Dental Surgery on the 13 July 2017.

We had undertaken an announced comprehensive inspection of this service on the 8 June 2017 as part of our regulatory functions where breaches of legal requirements were found.

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

We reviewed the practice against two of the five questions we ask about services, is the service safe and well led? You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Inglemire Dental Surgery on our website at www.cqc.org.uk.

We revisited Inglemire Dental Surgery as part of this review and checked whether they had followed their action plan and to confirm that they now met the legal requirements. We carried out this unannounced inspection on 13 July 2017 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 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 well-led?

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

Background

Inglemire dental practice is in Hull and provides NHS and private treatment to adults and children.

There is a small step to access the premises for people who use wheelchairs and pushchairs. Car parking spaces are available near the practice.

The dental team includes two dentists, four dental nurses, a part time practice manager and a receptionist. The practice has two treatment rooms.

The practice is owned by an individual who is the principal dentist there. They have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run.

During the inspection we spoke with two dentists, three dental nurses, the receptionist and the practice manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday, Thursday & Friday 9am – 5pm

Tuesday 9am – 6:30pm

Wednesday 9am – 3:30pm

Our key findings were:

• The practice was clean and well maintained.
• The practice had infection control procedures which reflected published guidance.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• The practice had systems to help them manage risk.
• The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• The practice had thorough staff recruitment procedures.
• The practice had effective leadership. Staff felt involved and supported and worked well as a team.

There were areas where the provider could make improvements. They should:

• Review the practice’s systems in place for environmental cleaning taking into account current national guidelines.
• Review the practice's protocols for completion of dental care records taking into account guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.
• Review the processes and systems in place for seeking and learning from patient feedback with a view to monitoring and improving the quality of the service.

We carried out this announced inspection on 8 June 2017 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.

We told the NHS England area team and Healthwatch that we were inspecting the practice. They did not provide any information of concern.

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 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

Inglemire dental practice is in Hull and provides NHS and minimal private treatment to adults and children.

There is a small step access for people who use wheelchairs and pushchairs. Car parking spaces are available near the practice.

The dental team includes two dentists, four dental nurses, a part time practice manager and a receptionist. The practice has two treatment rooms.

The practice is owned by an individual who is the principal dentist there. They have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run.

On the day of inspection we collected 20 CQC comment cards filled in by patients and spoke with three other patients. This information gave us a positive view of the practice.

During the inspection we spoke with two dentists, three dental nurses, the receptionist and the practice manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday, Thursday & Friday 9am – 5pm

Tuesday 9am – 18:30

Wednesday 9am – 15:30

Our key findings were:

• The surgeries were cluttered and some equipment was visibly dirty.
• The decontamination process did not always reflect published guidance. We found the zoning could be improved upon in the surgeries to clarify clean and dirty areas. Decontamination of instruments was not always effective.
• We found improvements could be made to the segregation and disposal of clinical waste in accordance with relevant regulations taking into account guidance.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available apart from midazolam.
• The practice did not have systems in place to help them manage risk.
• The practice had safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• The practice did not have sufficiently robust staff recruitment procedures.
• The clinical staff provided patients’ care and treatment in line with current guidelines.
• Staff treated patients with dignity and respect.
• Dental care records were not stored securely.
• The appointment system met patients’ needs in most cases but we were told they were often kept waiting.
• Governance arrangements were not in place to support the smooth running of the practice; the practice did not have a structured plan in place to audit quality and safety including infection control and radiography.
• The practice did not have effective leadership.
• The practice asked staff and patients for feedback about the services they provided.
• The practice dealt with complaints positively and efficiently.

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

• Ensure the practice’s infection control procedures and protocols are suitable 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’.
• Ensure the practice has an effective policy regarding the storage of products identified under Control of Substances Hazardous to Health (COSHH) 2002 Regulations which ensures risk assessments are undertaken and that products are stored securely.
• Ensure waste handling protocols are in place to ensure it is segregated and disposed of in accordance with relevant regulations taking into account guidance issued in the Health Technical Memorandum 07-01 (HTM 07-01).
• Ensure the practice has protocols and procedures for use of X-ray equipment taking into account Guidance Notes for Dental Practitioners on the Safe Use of X-ray Equipment.
• Ensure the practice’s sharps procedures are in compliance with the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.
• Ensure the practice availability of medicines to manage medical emergencies taking into account guidelines issued by the Resuscitation Council (UK), and the General Dental Council (GDC) standards for the dental team.
• Ensure the practice’s system for recording, investigating and reviewing incidents or significant events with a view to preventing further occurrences and ensuring that improvements are made as a result.
• Ensure the practice implements risk assessments to monitor and mitigate the various risks arising from undertaking of the regulated activities.
• Ensure audits of various aspects of the service, such as radiography and infection prevention and control are undertaken at regular intervals to help improve the quality of service. Practice should also ensure that where appropriate audits have documented learning points and the resulting improvements can be demonstrated.
• Ensure the practice reviews the recruitment policy and procedures to ensure they 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 there are training, learning and development needs of individual staff members at appropriate intervals and ensure an effective process is established for the on-going assessment, supervision and appraisal of all staff.

Full details of the regulations the provider was not meeting are at the end of this report.

There were areas where the provider could make improvements. They should:

• Review the security of prescription pads in the practice and ensure there are systems in place to track and monitor their use.
• Review the practice’s systems in place for environmental cleaning taking into account current national guidelines.
• Review stocks of medicines and equipment and the system for identifying, disposing and replenishing of out-of-date stock.
• Review the practice’s protocols for the use of rubber dam for root canal treatment taking into account guidelines issued by the British Endodontic Society.
• Review the practice’s arrangements for receiving and responding to patient safety alerts, recalls and rapid response reports issued from the Medicines and Healthcare products Regulatory Agency (MHRA) and through the Central Alerting System (CAS), as well as from other relevant bodies, such as Public Health England (PHE).
• Review the practice's protocols for completion of dental care records taking into account guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.
• Introduce protocols regarding the prescribing and recording of antibiotic medicines taking into account guidance provided by the Faculty of General Dental Practice in respect of antimicrobial prescribing.
• Review staff awareness of the requirements of the Mental Capacity Act (MCA) 2005 and ensure all staff are aware of their responsibilities under the Act as it relates to their role.
• Review the practice's storage of dental care records and records relating to people employed and the management of regulated activities having regard to legislation and taking into account current guidance.
• Review the processes and systems in place for seeking and learning from patient feedback with a view to monitoring and improving the quality of the service.

We are now taking further action in relation to this provider and will report on this when it is completed. Any regulatory decision that CQC takes is open to challenge by a registered person through a variety of internal and external appeal processes.

We spoke with patients while they were waiting to see the dentist and they confirmed they always completed consent forms prior to any treatment and options were discussed too. Comments included, “After they suggested I needed my treatment everything was explained to me”, “When my veneer came off a few times, the options were discussed” and “Yes I always sign a consent form and know what treatment I am having.”

People spoken with told us they had been fully informed of their treatment plans and that they had signed them. They made positive comments about the dental staff and commented, “I feel quite confident that any problems would be sorted out”, “The ladies are always friendly and helpful”, “It’s very good” and “The options are always given to me.”

People also told us they were treated with respect and as far as they were aware confidentiality was maintained.

People spoken with told us they thought the dental surgery was clean and hygienic and that on each visit the dentist and dental nurses had worn personal protective equipment such as face masks, glasses and gloves. They had also been given their own eye protection glasses.