We carried out this announced inspection on 15 November 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 that we were inspecting the practice. They did not provide any information.

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 providing well-led care in accordance with the relevant regulations.

Background

JD Dental Practice is in Sellyoak, Birmingham and provides NHS and private treatment to patients of all ages.

There is level access for people who use wheelchairs and pushchairs. The practice does not have a car park but patients have access to unrestricted parking on local side roads.

The dental team includes two dentists, three dental nurses, one dental therapist, one patient care manager, one clinical manager (who is also a registered dental nurse) and a business manager. Human resource support is also provided by an external contractor. The practice has three treatment rooms, one of which is on the ground floor.

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 spoke with two patients. This information gave us a positive view of the practice.

During the inspection we spoke with one dentist, one dental nurse, the patient manager, clinical manager and the business manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday, Wednesday and Friday 9am to 5pm and Tuesday and Thursday 9am to 8pm.

Our key findings were:

• The practice has been updated and refurbished recently and was clean and well maintained although a few loose wires were noted in the first floor treatment room.
• Evidence was not available to demonstrate that all equipment was serviced or maintained in accordance with manufacturer’s instructions.
• The practice had infection control procedures which reflected published guidance. Staff were not clearly identifying the date that pouched equipment required sterilising on all occasions.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• The practice had systems to help them manage risk although these were not robust.
• The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• The practice had thorough staff recruitment procedures although evidence of conduct in previous employment was not available for one member of staff.
• We did not see evidence that the principal dentist had completed continuous professional development in respect of dental radiography.
• The clinical staff provided patients’ care and treatment in line with current guidelines.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• The appointment system met patients’ needs.
• The practice had effective leadership. Staff felt involved and supported and worked well as a team.
• The practice asked patients for feedback about the services they provided.
• The practice dealt with complaints positively and efficiently.

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

• Review the practice’s sharps procedures and ensure the practice is in compliance with the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.
• Review the practice’s infection control procedures and protocols to take into account guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices and have regard to The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance’
• Review the systems for checking and monitoring equipment taking into account current national guidance and ensure that all equipment is well maintained.
• Review the protocols and procedures to ensure staff are up to date with their mandatory training and their Continuing Professional Development (CPD).
• Review the current performance review systems in place and have an effective process established for the on-going assessment and supervision of all staff.
• Review its responsibilities to the needs of people with a disability, including those with hearing difficulties and the requirements of the Equality Act 2010.

We undertook this unannounced focused inspection on 19 July 2016 to check that the provider had made the improvements we required at a previous inspection of this practice on 18 June 2015, when a breach of legal requirements was found.

At this focused inspection we checked to ensure that they had followed their plan and to confirm that they now met legal requirements. This report covers our findings in relation to those requirements. We also received some information of concern prior to our inspection; these issues were reviewed as part of this process. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for JD Dental Practice on our website at www.cqc.org.uk

Our findings were:

Are services well-led?

We found that this practice was not providing well-led care in accordance with the relevant regulations.

Background

CQC inspected the practice on 18 June 2015 and asked the provider to make improvements regarding Regulation 17 of the Health and Social Care Act. We checked these areas as part of this follow up inspection and found that not all actions had been completed. However, when we arrived for this inspection we found the practice was closed to patients as a refurbishment was under way, and the plans included improvement work against some of the points in the previous inspection report.

The principal dentist is registered with the Care Quality Commission (CQC) as an individual. 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 identified regulations that were not being met and the provider must:

• Ensure the practice’s infection control audits, 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’s sharps handling procedures and protocols are in compliance with the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.

• Ensure audits of various aspects of the service, such as radiography are undertaken at regular intervals to help improve the quality of service. Practice should also ensure all audits have documented learning points and the resulting improvements can be demonstrated.

• Ensure an effective system is established to assess, monitor and mitigate the various risks arising from undertaking of the regulated activities.

You can see full details of the regulation not being met at the end of this report.

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

• Review systems for recording accidents and other significant events to ensure that remedial action and learning takes place when adverse incidents occur.

• 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 and consistently apply recruitment procedures which fully reflect the requirements of Regulation 19(3) and Schedule 3 of the Health & Social Care Act 2008 (Regulated Activities) Regulations 2014.

• Review and improve staff induction process to include a structured assessment of the competence of new staff for their role and responsibilities.

• Review the practice's protocols for completion of dental records giving due regard to guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.

• Review the practices complaints procedures and establish an effective procedure for acknowledging, recording, investigating and responding to complaints, concerns and suggestions made by patients.

• Review systems to ensure that staff are aware of all policies and procedures that are in place.

Other areas for improvement covered in the refurbishment were to review the suitability of the decontamination room and staff kitchen facilities and to implement the findings of the Disability Discrimination Act 2005 assessment.

We carried out an announced comprehensive inspection on 18 July 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 respects 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.

JD Dental Surgery provides mainly NHS dental treatment although staff told us they also carry out a small amount of private treatment. The practice is situated in a residential area of Birmingham with a mixed population where some people are living in deprived circumstances whilst others are more affluent. The area has a diverse population of people from different ethnic origins and a high student population.

JD dental practice has one dentist, one dental hygienist, one dental nurse and a practice manager. Two other members of the practice team were on maternity leave. The practice has three dental treatment rooms (one of which was out of use) and a decontamination room for the cleaning, sterilising and packing of dental instruments. The reception area and waiting room are on the ground floor.

Before the inspection we sent Care Quality Commission comment cards to the practice for patients to use to tell us about their experience of the practice. We collected 17 completed cards. These provided a positive view of the service the practice provides. Patients told us the practice was welcoming and that the dentist was understanding, thorough and helpful. Several patients specifically commented that the dentist put them at ease. The dentist provided dental care to people living in eight care homes in the area. We spoke with senior staff from those homes. They were generally very positive about the service people received and highlighted that the dentist was particularly good at understanding the needs of people living with dementia illnesses.

Our key findings were:

• The practice had no records of significant events or accidents to ensure they investigated these and took remedial action. There was no evidence of learning when adverse incidents happened.
• The practice was visibly clean but some areas of the building needed to be improved.

• The practice had systems to assess and manage risks to patients for infection prevention and control (IPC) and the management of medical emergencies but was not carrying out IPC audits to test the effectiveness of infection control procedures.

• The practice had safeguarding processes and staff understood their responsibilities for safeguarding adults and children.

• Recruitment policies and procedures did not ensure that all of the required checks for new staff were completed.

• The content of clinical records was brief, but included the essential information expected about patients’ care and treatment.

• Staff had received training appropriate to their roles and were supported in their continued professional development (CPD).

• The practice did not have an established effective system for handling and responding to complaints made by patients.

• 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.

• Patients were able to make routine and emergency appointments when needed.

• The practice did not have effective systems in place to assess, monitor and improve the quality and safety of the services provided.

• The practice did not have effective systems in place to assess, monitor and mitigate the risks relating to the health, safety and welfare of patients, staff and visitors.

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.
• Establish an effective system to assess, monitor and mitigate the risks relating to the health, safety and welfare of patients, staff and visitors.

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:

• Introduce effective systems for recording accidents and other significant events to ensure that remedial action and learning takes place when adverse incidents occur.
• Provide separate protective face visors in the decontamination room from those used in the treatment rooms to avoid the potential for cross contamination.
• Establish a process to audit and monitor infection prevention and control arrangements at the practice.
• Routinely use a rubber dam (or suitable alternative) during root canal work. A rubber dam is a thin, rectangular sheet, usually latex rubber, used in dentistry to isolate the operative site from the rest of the mouth.
• Update their policies and procedures for the safe use of dental sharps to reflect the requirements of the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013 and the EU Directive on the safer use of sharps which came into force in 2013
• Consistently apply recruitment procedures which fully reflect the requirements of Regulation 19(3) and Schedule 3 of the Health & Social Care Act 2008 (Regulated Activities) Regulations 2014.
• Review and update their Disability Discrimination Act 2005 assessment of the building and make firm plans to improve the facilities based on the findings of this.
• Review the suitability of the decontamination room and staff kitchen facilities.
• Make more detailed records of the care and treatment provided to patients.
• Establish an effective procedure for acknowledging, recording, investigating and responding to complaints, concerns and suggestions made by patients.
• Improve the staff induction process to include a structured assessment of the competence of new staff for their role and responsibilities.

Our visit was arranged with the practice in advance 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 one dentist (who was also the registered provider), two dental nurses and one receptionist and observed two consultations. After our inspection visit, we spoke by telephone with eight people who were registered with the practice to ask them about their experiences of the service and received written comments from two people.

All the people we spoke with were happy with the service they had received. Their comments included, “Everything is absolutely fine” and “I have had very good treatment there.” 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 they had no concerns about the cleanliness and hygiene at the practice. The registered provider made some improvements following the inspection to ensure the arrangements for infection control were robust.

People using the service were asked their views about the service so the provider could use the information to improve.