We carried out an announced comprehensive inspection of this practice on 25 November 2015 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We found the registered provider was providing safe, effective, caring and responsive care in accordance with relevant regulations.

A breach of legal requirements was found and we judged that 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.

After the comprehensive inspection, the practice wrote to us to say what they would do to meet legal requirements in relation to the breach.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Kings Heath Dental Practice on our website at www.cqc.org.uk.

We carried out this announced follow up inspection on 17 July 2017 to ask the practice the following key question: Are services well-led?

Our findings were:

Are services well-led?

We found that the provider had taken effective action to deal with the shortfalls we found at our inspection on 25 November 2015. We found that this practice was providing well-led care in accordance with regulation 17.

We carried out an announced comprehensive inspection on 25 November 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 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

Kings Heath Dental Practice has three dentists who each work part time, a dental hygienist, three dental nurses and three reception staff. Two of the dental nurses work flexible part time hours. All of the dental nurses are qualified and registered with the General Dental Council (GDC). The practice opens at 8.15am each morning from Monday to Friday and closing times vary between 6.30pm on Monday to 2pm on Fridays.

Kings Heath Dental Practice provides both NHS and private treatment for adults and children. The practice is situated in a converted residential property. There are four dental treatment rooms; and a separate room used to complete part of the decontamination process for cleaning, sterilising and packing dental instruments. There is also a reception and waiting area.

The practice owner is the 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 Care Quality Commission comment cards to the practice for patients to complete to tell us about their experience of the practice, we also spoke with patients during the inspection. We received feedback from 35 patients who provided an overall positive view of the services the practice provides. Three patients commented that there could occasionally be a wait to see the dentist after their appointment time but also praised the practice. All of the patients commented that the quality of care was good.

Our key findings were:

• The practice had mechanisms in place to record significant events and accidents.
• The practice had effective safeguarding processes in place and staff understood their responsibilities for safeguarding adults and children
• The practice had enough staff to deliver the service.
• Some infection prevention and control systems were in place, although audits were not completed on a six monthly basis.
• Patients were treated with dignity and respect and confidentiality was maintained.
• The practice kept up to date with current guidelines when considering the care and treatment needs of patients.
• Health promotion advice was given to patients appropriate to their individual needs such as smoking cessation or dietary advice.
• Patients felt involved in all treatment decisions and were given sufficient information, including details of costs to enable them to make an informed choice.
• The appointment system met the needs of patients and waiting times were kept to a minimum
• Feedback from 35 patients gave us a completely positive picture of a friendly, caring and professional service.
• The practice had implemented clear procedures for managing comments, concerns or complaints.

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. This should include lone working, systems to maintain and monitor emergency medicine and equipment, staff training, clinical waste, infection prevention and control and fire systems including risk assessments. Where appropriate X-ray signage must be in place.

• Ensure that effective recruitment procedures are in place to assess the suitability of staff for their role. Not all the specified information (Schedule 3) relating to persons employed at the practice was obtained.

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:

• Establish a system for recording and monitoring of expiry dates of dental items used in the treatment of patients, for example rubber dam kits.
• Put into place a system to record and monitor medicine refrigerator temperatures.
• Review emergency medicines in line with the Guidance on Emergency Medicine as set out in the British National Formulary (BNF).
• Review lone working arrangements in accordance with the General Dental Council standards for the dental team in order to ensure the safety of staff and patients.
• Provide patients with a copy of any letter of referral to another dental service.
• Develop a system to monitor and record staff training, including induction to make sure that training is undertaken at appropriate intervals so that staff are competent to carry out the duties they are employed to perform and to meet their continuing professional development requirements.
• Provide evidence to demonstrate that actions identified in the legionella risk report are addressed and an updated assessment is undertaken by a company registered with the legionella control association as per the practice’s protocol.
• Review staff awareness of dental water lines maintenance to prevent the growth and spread of legionella bacteria.
• Review the practices’ risk logs to make sure that they are fully completed.
• Review  standardised policies and amend these to meet the needs of the practice.

This review visit was discussed and arranged with the practice a few days in advance. This was to ensure that we had time to see and speak to staff working at the practice, as well as people registered with the practice.

As part of our visit, we spoke with a number of people who were registered with the practice by telephone and by email. One person contacted us to provide their feedback on the practice. We also spoke with the senior dentist and their staff about working at the practice.

People that used the practice told us that they were happy with the quality of treatment received. They felt they were given enough information about their treatment options and the relevant fees, and were able to ask all the questions they wanted to.

We visited this practice because we received comments which indicated that the provider may not be meeting the required standards.

We found there were good arrangements for infection control at the practice. These included the use of protective equipment and procedures for keeping instruments clean.

We spoke with several people who used the service. They told us they were pleased with their own treatment and, in emergencies, they could always obtain an appointment at short notice. One person told us they were, “quite satisfied” with the service. Another said that they had been using the practice for many years and had no concerns.

The records in the practice showed that people had raised concerns about charges and long waiting times. The provider told us the action he had taken to address these issues. We saw that charges were clearly displayed in waiting and reception areas.

We found that there were good arrangements for making sure that people using the service were kept safe. These included staff training in adult and child protection and relevant contact numbers for staff to report concerns.

There were arrangements for making sure that standards were monitored and improved, where necessary. These included surveys and a complaints book. The systems which we saw had recently been introduced. The provider told us that he has plans to continue to use these and make improvements, including developing more comprehensive surveys of patients.