We carried out this inspection to follow up concerns we originally identified during a comprehensive inspection at the practice on 28 November 2017 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions.

At a comprehensive inspection we always ask the following five questions to get to the heart of patients’ experiences of care and treatment:

• Is it safe?
• Is it effective?
• Is it caring?
• Is it responsive to people’s needs?
• Is it well-led?

When one or more of the five questions is not met, we require the service to make improvements and send us an action plan. We then inspect again after a reasonable interval, focusing on the area where improvement was required.

At the previous comprehensive inspection, we found the registered provider was providing safe, effective, caring and responsive care in accordance with relevant regulations. We judged the practice was not providing well-led care in accordance with Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can read our report of that inspection by selecting the 'all reports' link for J G Glen Practice on our website www.cqc.org.uk.

During this inspection, we spoke with the practice manager and principal dentist. We checked the premises and reviewed a range of documentation in relation to the management of the practice.

Our findings were:

• The provider had made satisfactory improvement to put right most of the shortfalls we found at our previous inspection. The provider must ensure that all newly implemented improvements are embedded and sustained in the long- term in the practice.

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

• Ensure that the name and address of the practice are displayed on all private prescriptions issued to patients.
• Infection control audits should be undertaken every six months in line with current guidance

We carried out this announced inspection on 28 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. A CQC inspector, who was supported by a specialist dental adviser, led the inspection.

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 not providing well-led care in accordance with the relevant regulations.

Background

J G Glen Dental Practice provides private dentistry to patients of all ages. The dental team consists of two dentists, a part-time hygienist and two dental nurses. The practice has two treatment rooms and is open on Mondays from 9am to 7pm; Tuesdays from 9pm to 5pm; Wednesdays from 9am to 3pm; Thursdays from 9am to 7pm, and on Fridays from 9am to 2pm.

There is ramp access for wheelchair and pushchair users at the entrance of the building.

The practice is owned by an individual who is the principal dentist, Dr Romeo Young. He has 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 the principal dentist and two dental nurses. We looked at the practice’s policies and procedures, and other records about how the service was managed. We collected 18 comment cards filled in by patients prior to our inspection.

Our key findings were:

• We received positive comments from patients about the dental care they received and the staff who delivered it.

• The practice had suitable safeguarding processes and staff knew their responsibilities for protecting adults and children.

• The appointment system met patients’ needs and the practice opened late two evenings a week.

• The practice was clean and well maintained, and had infection control procedures that reflected published guidance.

• Staff knew how to deal with medical emergencies, although not all equipment recommended by the British National Formulary, the Resuscitation Council (UK), and the General Dental Council (GDC) standards was available.

• The practice’s sharps handling procedures and protocols complied with the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.

• There was no system in place to ensure that untoward events were analysed and used as a tool to prevent their reoccurrence.

• Systems to ensure the safe recruitment of staff were not robust, as essential pre-employment checks had not been completed.

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

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care. This includes the recording and monitoring of significant events; ensuring appropriate medical emergency equipment is available, responding to national patient safety alerts, and ensuring staff receive regular appraisal 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.

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

• Review the storage of dental care products and medicines requiring refrigeration to ensure they are stored in line with the manufacturer’s guidance and the fridge temperature is monitored and recorded.

• Review practice protocols for patient assessments and ensure they are in compliance with current legislation and take into account relevant nationally recognised evidence-based guidance.

• Review the practice’s protocols for recording in the patients’ dental care records the reason for taking the X-ray and quality of the X-ray giving due regard to the Ionising Radiation (Medical Exposure) Regulations (IR(ME)R) 2000. Review the analysis of the grades for the quality of radiographs to ensure these are correctly recorded over each audit cycle and for each dentist.

• Review the practice's protocol and staff awareness of their responsibilities under the Duty of candour to ensure compliance with The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.