We carried out a follow-up inspection at Lowton Dental Centre on 1 December 2017.

We had undertaken an announced comprehensive inspection of this service on the 27 July 2017 as part of our regulatory functions where a breach of legal requirements was found.

After the comprehensive inspection, the practice wrote to us to say what they would do to meet the legal requirements in relation to the breach. This report only covers our findings in relation to those requirements. We checked whether they had followed their action plan to confirm that they now met the legal requirements.

We reviewed the practice against one of the five questions we ask about services: are the services well led? You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Lowton Dental Centre on our website at www.cqc.org.uk.

We revisited Lowton Dental Centre as part of this review and checked whether they now met the legal requirements. We carried out this announced inspection on 1 December 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.

We reviewed the practice against oneof the five questions we ask about services: is the service well-led?

The inspection was led by a CQC inspector who had remote access to a specialist dental adviser.

Our findings were:

Are services well-led?

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

Background

Lowton Dental Centre is in Lowton, Cheshire and provides NHS and private treatment to adults and children. The practice is also contracted to provide NHS orthodontic treatment.

A portable ramp is available for people who use wheelchairs and pushchairs. Car parking spaces, including for patients with disabled badges, are available near the practice.

The dental team includes three dentists, four dental nurses (three of which are trainees), a dental hygienist, two dental hygiene therapists, an orthodontic therapist and a receptionist. The practice has five treatment rooms.

The practice is owned by a 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 Lowton Dental Centre was the principal dentist.

During the inspection we spoke with the principal dentist and the practice manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday 9.00 - 13.00 14.00 - 17.45

Tuesday 9.00 - 13.00 14.00 - 17.45

Wednesday 9.00 - 13.00 14.00 - 17.45

Thursday 9.00 - 13.00 14.00 - 19.30

Friday 8.00 - 13.00

Our key findings were:

• An effective system was now in place for staff to report incidents and significant events.
• A system for the control of Legionella was now in place.
• Policies, procedures and the systems to help them manage risk had been reviewed.
• Dental care records were now stored securely.
• Improvements had been made to the practice’s quality assurance processes.
• The practice had reviewed their procedures for closed-circuit television (CCTV).

We carried out this announced inspection on 27 July 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.

We told the NHS England area team that we were inspecting the practice. We did not receive any information of concern from them.

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

Lowton Dental Centre is in Lowton, Cheshire and provides NHS and private treatment to adults and children. The practice is also contracted to provide NHS orthodontic treatment.

A portable ramp is available for people who use wheelchairs and pushchairs. Car parking spaces, including for patients with disabled badges, are available near the practice.

The dental team includes three dentists, four dental nurses (three of which are trainees), a dental hygienist, two dental hygiene therapists, an orthodontic therapist and a receptionist. The practice has five treatment rooms.

The practice is owned by a 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 Lowton Dental Centre was the principal dentist.

On the day of inspection we collected 18 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 two dentists, two dental nurses, the dental hygienist, the orthodontic therapist, the receptionist and the practice manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday 9.00 - 13.00 14.00 - 17.45

Tuesday 9.00 - 13.00 14.00 - 17.45

Wednesday 9.00 - 13.00 14.00 - 17.45

Thursday 9.00 - 13.00 14.00 - 19.30

Friday 8.00 - 13.00

Our key findings were:

• The practice was clean and well maintained.
• The practice had infection control procedures which reflected published guidance but improvements were needed in the control of Legionella.
• Staff knew how to deal with emergencies. Improvements could be made to the medicines and life-saving equipment available.
• Policies, procedures and the systems to help them manage risk could be improved.
• Staff knew their responsibilities for safeguarding adults and children.
• 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.
• 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 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 by ensuring:

• effective practice specific policies and procedures are established to assess, monitor and mitigate the various risks arising from undertaking of the regulated activities.
• mandatory audits of aspects of the service, such as radiography records are undertaken at regular intervals to help improve the quality of service. The practice should also ensure all audits have documented learning points and the resulting improvements can be demonstrated.
• risk assessments are carried out to minimise the risk of sharps injuries and the risk from hazardous products.
• a system is in place to record, investigate and learn from incidents.
• the secure storage of dental care records is in accordance with current legislation and guidance.

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

• Review availability of equipment to manage medical emergencies taking into account guidelines issued by the Resuscitation Council (UK), and the General Dental Council (GDC) standards for the dental team.
• Review the current legionella risk assessment and implement the recommended actions including the monitoring and recording of water temperatures, having due regard to the 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 its responsibilities as 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.
• Establish whether the practice is in compliance with its legal obligations under the Ionising Radiations Regulations 1999 and the Ionising Radiation (Medical Exposure) Regulations 2000.
• Review the practice’s procedures for closed-circuit television (CCTV) and compliance with the Information Commissioner’s office protocols (ICO).

"The Dentist examines my mouth before treatment starts"

"I was able to get an emergency appointment and was seen very fairly quickly."

" I have attended this dentists for years - I would'nt like to go anywhere else".

" I am very happy with the treatment I get here".