We carried out a follow- up inspection at the Kingston Road Dental Practice on the 20 December 2016.

We had undertaken an announced comprehensive inspection of this service on the 10 May 2016 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 one of the five questions we ask about services: is the service safe? You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Kingston Road Dental Practice on our website at www.cqc.org.uk.

We revisited the Kingston Road Dental Practice as part of this review and checked whether they had followed their action plan and to confirm that they now met the legal requirements.

Our findings were:

Are services safe?

We found that this practice was providing safe care in accordance with the relevant regulations.

Background

Kingston Road Dental practice provides private and NHS dental services to children and adults at the surgery on Kingston Road, Willerby, East Riding of Yorkshire. The practice has two treatment rooms on the first floor, a waiting area, a reception area and a decontamination room. Staff facilities were located on the ground floor.

Due to the surgeries being located on the first floor, patients with mobility requirements are referred to a local practice which was more accessible.

There is one dentist who is supported by three dental nurses (one of whom is a trainee).

The practice is open:

Monday –Friday 09:00 – 13:00 14:00 – 17:30

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.

Our key findings were:

• The practice had systems in place to assess and manage risks to patients and staff including infection prevention and control, health and safety and the management of medical emergencies.
• The practice was visibly clean and tidy.

• Detailed COSHH risk assessments for materials were now in place
• Infection control procedures were in accordance with the guidance published by the Department of Health.
• Oral health advice and treatment were provided in line with the ‘Delivering Better Oral Health’ toolkit (DBOH).
• Treatment was well planned and provided in line with current best practice guidelines.

We carried out an announced comprehensive inspection on 10 May 2016 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 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 providing well-led care in accordance with the relevant regulations.

Background

Kingston Road Dental practice provides private and NHS dental services to children and adults at the surgery on Kingston Road, Willerby, East Yorkshire. The practice has two treatment rooms on the first floor, a waiting area, a reception area and a decontamination room. Staff facilities were located on the ground floor.

Due to the practice surgeries being located on the first floor, patients with mobility requirements are referred to a local practice which was more accessible.

There is one dentist who is supported by two full time dental nurses and two part time dental nurses.

The practice is open:

Monday –Friday 09:00 – 13:00 14:00 – 17:30

The principal dentist is registered with the Care Quality Commission (CQC) as an individual. 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.

During the inspection we received feedback from 19 patients. The patients who provided feedback were very positive about the care and attention to treatment they received at the practice. They told us they were involved in all aspects of their care and found the staff to be kind, polite and considerate. Patients commented they could access emergency care easily and they were treated with dignity and respect in a clean and tidy environment.

Our key findings were:

• Staff had received safeguarding training, knew how to recognise signs of abuse and how to report it. They had very good systems in place to work closely and share information with the local safeguarding team.
• There were sufficient numbers of suitably qualified staff to meet the needs of patients.
• Staff had been trained to manage medical emergencies.
• Patient care and treatment was planned and delivered in line with evidence based guidelines, best practice and current regulations.
• Patients received clear explanations about their proposed treatment, costs, benefits and risks and were involved in making decisions about it.
• Patients were treated with dignity and respect and confidentiality was maintained.
• There was a complaints system in place. Staff recorded complaints and cascaded learning to staff.
• The governance systems were effective.
• The practice sought feedback from staff and patients about the services.

We identified regulations that were not being met and the provider 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 implements the required actions from the Legionella risk assessment, 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’ the HSE Legionnaires’ disease Approved Code of Practice and guidance on regulations L8.
• Ensure COSHH risk assessments are implemented for all materials used within the practice. Review the practice responsibility in regards to the Control of Substance Hazardous to Health (COSHH) Regulations 2002 and, ensure all documentation is up to date and staff understand how to minimise risks associated with the use of and handling of these substances.

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:

• Review the practice’s sharps handling procedures and protocols are in compliance with the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013 and implement a risk assessment to support this.
• Review the practice protocol for X-ray audits to ensure they are carried out annually and ensure they are carried out in line with the National Radiological Protection Board (NRPB) guidelines.
• Review the practice’s protocols for recording in the patients’ dental care records or elsewhere 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 dental care records are maintained appropriately giving due regard to guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.
• Review the practice protocols for fire drills to ensure they are undertaken at an interval set within the fire risk assessment.

• Review the practice’s system for identifying and disposing of out-of-date stock.
• Review the practice protocols and adopt an individual risk based approach to patient recalls giving due regard to National Institute for Health and Care Excellence (NICE) guidelines.

We spoke with two people that used the service and they told us they had been quite satisfied with the treatment they had received as they had been coming to the surgery for a number of years. They said the service had been professional, reliable and friendly and the dentist was skilled. They told us that as 'patients' they had always been made welcome and were reassured by all of the staff at the surgery.

People told us they signed documentation to give their consent to treatment and that staff checked peoples' medical histories and medication on a regular basis.

People told us they found the surgery to be clean and hygienic and that staff had high standards of cleanliness and infection control. When we looked round the surgery we saw evidence that the premises were kept clean. We also saw evidence of effective infection control systems in place and good practice being followed.

When we looked at training records we saw evidence that the dentist and dental nurses had been professionally trained to the level their positions required and that they had completed training in other appropriate courses. They had completed safeguarding children training but not safeguarding adults training and this was highlighted.

We saw evidence that there was a quality monitoring system in place that informed the future performance of the service.