We carried out a focused inspection of Longwell Green Dental Surgery on 13 November 2017.

The inspection was led by a CQC inspector who had access to telephone support from a dental clinical adviser.

We carried out the inspection to follow up concerns we originally identified during a comprehensive inspection at this practice on 20 June 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 Good Governance 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 Longwell Green Dental Surgery on our website www.cqc.org.uk.

We also reviewed some of the key questions of safe and effective as we had made recommendations for the provider relating to these key questions. We noted that improvements had been made.

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 to put right the shortfalls and dealt with the regulatory breach we found at our inspection on 20 June 2017.

We carried out this announced inspection on 7 June 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.

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

Longwell Green Dental Surgery is in Longwell Green and provides solely private treatment to patients of all ages.

The practice is based on the first floor of a building with stairs for access. There is no level access for patients who use wheelchairs and pushchairs. There are approximately 10 car parking spaces available outside the practice which is shared with other services within the building. There are no allocated disabled parking bays.

The dental team includes four dentists, five dental nurses, one dental hygienist who is also a qualified dental therapist and five receptionists. The practice has four treatment rooms.

The practice is owned by a limited company and as a condition of registration must have a person registered with the Care Quality Commission as the registered manager. Registered managers have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run. The registered manager at Longwell Green Dental Surgery was the practice manager.

On the day of inspection we collected 13 CQC comment cards filled in by patients and spoke with three other patients. This information gave us a positive view of the practice.

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

The practice is open:

• Monday to Thursday 8am to 8pm
• Fridays 8am to 4:30pm
• Saturday appointments are available upon request

Our key findings were:

• The practice appeared clean and well maintained.
• The practice had infection control procedures which reflected published guidance. Although infection control audits were not completed on a six monthly basis as required.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment was available.
• The practice needed to improve how it managed medicines to ensure they were stored and monitored appropriately.
• The practice had systems to help them manage risk. Although these must be further improved to ensure a risk assessment is carried out on all rooms in the premises to minimise risks to patients.
• The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children. Although we found not all staff had received child safeguarding training.
• The practice had to improve staff recruitment procedures to ensure they followed current legislation when recruiting staff.
• 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 staff and patients for feedback about the services they provided.
• The practice dealt with complaints positively and efficiently.

We identified an example of notable practice. The provider had a staff recognition system called STAR where anyone can nominate members of staff who they deem to have gone above and beyond in their role. A panel would then decide who would receive the award on a monthly and annual basis. The winner would receive a prize.

We identified regulations the provider was not meeting. They must:

• Ensure the practice's recruitment policy and procedures were suitable and the recruitment arrangements were in line with Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 to ensure necessary employment checks were in place for all staff and the required specified information in respect of persons employed by the practice was held.

Full details of the regulations the provider was not meeting are at the end of this report.

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

• Introduce protocols regarding the prescribing and recording of antibiotic medicines in consideration of guidance provided by the Faculty of General Dental Practice in respect of antimicrobial prescribing.
• Review the current staffing arrangements to ensure all dental care professionals are adequately supported by a trained member of the dental team when treating patients in a dental setting taking into account the guidance issued by the General Dental Council.
• Review systems for the proper and safe management of medicines. For example, medicines should be monitored to ensure there was an effective audit trail and stored within required temperatures.
• Review the storage of products identified under Control of Substances Hazardous to Health (COSHH) 2002 Regulations to ensure they are stored securely.
• Review the practice’s auditing of infection control procedures 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.

• Review the practice’s staff training ensuring all staff are trained to an appropriate level for their role in child safeguarding and aware of their responsibilities.