We undertook a focused inspection of Kidsgrove Dental & Implant Centre on 19 February 2019. This inspection was carried out to review in detail the actions taken by the registered provider to improve the quality of care and to confirm that the practice was now meeting legal requirements.

The inspection was led by a CQC inspector who was supported by a specialist dental adviser.

We undertook a comprehensive inspection of Kidsgrove Dental & Implant Centre on 24 October 2018 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We found the registered provider was not providing well-led care and was in breach of 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 Kidsgrove Dental & Implant Centre on our website www.cqc.org.uk.

As part of this inspection we asked:

• Is it well-led?

When one or more of the five questions are 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 areas where improvement was required.

Our findings were:

Are services well-led?

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

The provider had made improvements in relation to the regulatory breach we found at our inspection on 24 October 2018.

Background

Kidsgrove Dental and Implant Centre is located close to the town centre of Kidsgrove on the northern outskirts of Stoke-on-Trent. The practice provides mostly private dental treatment to adults with a small NHS contract for children. This follow-up report relates to the private dental service.

There is a ramp with a handrail fitted to one side up to the entrance. The practice has three treatment rooms, one of which is located on the ground floor. This is of benefit for people who use wheelchairs and those with pushchairs. There is roadside parking available in the area around the practice.

The dental team includes two dentists, one dental hygienist, one dental hygiene therapist, two qualified dental nurses, one trainee dental nurse, one receptionist and one business director.

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 one dentist and two dental nurses. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open: Monday: 9am to 7pm, Tuesday: 9am to 5pm, Wednesday: 9am to 7pm, Thursday: 9am to 5pm and Friday: 9am to 4pm. The practice is closed on Saturday and Sunday.

Our key findings were:

• The provider had improved the way in which sharps were handled and managed within the practice. Only clinicians handled sharps and equipment had been purchased to enable safe removal of needles.

• A new Legionella risk assessment had been completed on 3 December 2018 by an external company. Actions identified in the risk assessment had been completed.

• Improvements had been made regarding cleaning dental instruments. Manual cleaning was only being used as a back-up, and appropriate checks and tests were being completed on the ultrasonic cleaners.

• Emergency equipment had been replaced where necessary, and a new first aid box had been purchased.

• Checklists have been introduced for the external cleaning company and the premises were visibly clean and tidy.

• Audits had been completed for several areas in the practice. There were no action plans from the audits, and in some cases the detail was very brief.

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

• Review the practice’s protocols to ensure audits of radiography and infection prevention and control are undertaken at regular intervals to improve the quality of the service. Practice should also ensure that, where appropriate, audits have documented learning points and the resulting improvements can be demonstrated.

We carried out this announced inspection on 24 October 2018 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 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

Kidsgrove Dental and Implant Centre is located close to the town centre of Kidsgrove on the northern outskirts of Stoke-on-Trent. The practice provides private dental treatment to adults.

The provider has two registrations with the Care Quality Commission. One is for private dental treatment and one for treatment carried out under an NHS contract. Both were inspected at the same time, and as a result there are two reports, which only differ very slightly. This report relates to the private registration.

There is a ramp with a handrail fitted to one side up to the entrance. The practice has three treatment rooms, one of which is located on the ground floor. This is of benefit for people who use wheelchairs and those with pushchairs. There is roadside parking is available in the area around the practice.

The dental team includes two dentists, one dental hygienist, one dental hygiene therapist, two qualified dental nurses, one trainee dental nurse, one receptionist and one business director.

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 received feedback from 11 patients.

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

The practice is open: Monday: 9am to 7pm, Tuesday: 9am to 5pm, Wednesday: 9am to 7pm, Thursday: 9am to 5pm and Friday: 9am to 4pm. The practice is closed on Saturday and Sunday.

Our key findings were:

• There were areas of the practice that did not appear clean and well maintained.
• Procedures used to clean dental instruments did not always follow the guidance: Health Technical Memorandum 01-05: Decontamination in primary care dental practices (HTM01-05)
• The practice had systems to help them manage risk.
• The equipment used for medical emergencies was not all in date or ready to use.
• The practice did not have a Legionella risk assessment.
• The practice staff had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• The practice had all the staff records required by schedule three of the Health and Social Care Act (2008)
• The practice’s sharps procedures were not in compliance with the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.
• 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 practice was providing preventive care and supporting patients to ensure better oral health.
• The appointment system met patients’ needs.
• The X-ray machines were fitted with rectangular collimation and there were digital X-rays to ensure patients and staff were exposed to the lowest possible dose of radiation.
• There was scope for improvement regarding audits completed in the practice.

Full details of the regulation/s the provider was/is not meeting are at the end of this report.

We identified regulations the provider was not complying with. They must:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care

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

• Review the practice’s systems for environmental cleaning taking into account the guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices.

• Review staff training to ensure that dental nursing staff who assist in conscious sedation have the appropriate training and skills to carry out the role, taking into account guidelines published by The Intercollegiate Advisory Committee on Sedation in Dentistry in the document 'Standards for Conscious Sedation in the Provision of Dental Care 2015'.