We carried out a follow- up inspection on 13 September 2016 at M I Bholah Dental Practice.

We had undertaken an announced comprehensive inspection of this service 30 March 2016 as part of our regulatory functions where breach 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 the breach. This report only covers our findings in relation to those requirements.

We reviewed the practice against two of the five questions we ask about services: is the service safe and well-led?

We revisited M I Bholah 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.

Are services well-led?

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

Background

The practice is owned by Mr. M I Bholah. The practice is located on the ground floor of the building. There is a combined reception and waiting area, a washroom, a surgery and a decontamination room. The practice offers primary care dentistry under the NHS and private dental care.

The practice is open Monday to Friday 9.30am to 4.30pm.

There is a dentist and a dental nurse at the practice.

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.

Our key findings were:

• The system to check emergency medicines, the emergency oxygen and the automated external defibrillator was effective. All emergency medicines and equipment were in date and in line with guidance from the British National Formulary (BNF) and the Resuscitation Council UK.
• An Infection Prevention Society (IPS) self- assessment audit had been completed and an action plan had been formulated and actioned.
• Staff had completed training in infection control, the Mental Capacity Act (MCA) and safeguarding.
• The practice had ceased to provide conscious sedation.

We carried out an announced comprehensive inspection on 30 March 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 not providing well-led care in accordance with the relevant regulations.

Background

The practice is owned by Mr. M I Bholah. The practice is located on the ground floor of the building. There is a combined reception and waiting area, a washroom, and surgery and decontamination room. The practice offers primary care dentistry under the NHS, including conscious sedation, and private dental care.

The practice is open Monday to Friday 9.30am to 4.30pm.

There is a dentist a dental nurse and a trainee dental nurse at the practice.

The principal dentist Mr M I Bholah 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.

We spoke with the dentist and both dental nurses.

On the day of inspection we received 18 CQC comment cards providing feedback. The patients who provided feedback were positive about the care and attention to treatment they received at the practice. They found the staff to be polite, friendly, helpful, efficient and professional. The practice was clean and tidy on the day of the inspection.

Our key findings were:

• There was an effective complaints system.
• There were sufficient numbers of qualified staff to meet the needs of patients.
• Patient care and treatment was planned and delivered in line with evidence based guidelines 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.
• Patients could access routine treatment and urgent care when required.
• The practice sought feedback from staff and patients about the services they provided in order to make improvements where needed.

We identified regulations that were not being met and the provider must:

• Ensure the training, learning and development needs of staff members are reviewed at appropriate intervals and relevant training is undertaken when required.

• Ensure all staff are aware of their responsibilities under the Mental Capacity Act (MCA) 2005 and the principles of the Gillick and Fraser competency guidance as it relates to their role.

​You can see full details of the regulations not being met at the end of this report.

There was an area where the provider could make improvements and should:

• Review availability of equipment and medicines to manage medical emergencies giving due regard to guidelines issued by the Resuscitation Council (UK) standards for the dental team.

• Review the practice’s protocols for the use of rubber dam for root canal treatment giving due regard to guidelines issued by the British Endodontic Society

• Review the current decontamination processes and techniques and implement the required actions including the manual cleaning instruments under water before being sterilised, giving 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 the practice approach to supporting safe lone working arrangements for staff and implement a lone working policy.

• Review the practice’s protocol for undertaking audits including dental care records and infection prevention and control at regular intervals to help improve the quality of service. The practice should also ensure all audits have documented learning points so the resulting improvements can be demonstrated.

We saw people were given appropriate information about the service and the care and treatment they received. We spoke with three people who used the service who told us they understood the care and treatment choices available to them. One person said, "He (the dentist) talked me through everything. He is very good. He sits you down and explains what he’s going to do before he starts. Then when he’s working on your mouth he talks to you though things as he is doing it." Another person said, "Yes, it was all explained to me."

Care and treatment was planned and delivered in a way that was intended to ensure people’s safety and welfare. People told us they were happy with the care and treatments they had received. "It's champion. I had some dentures fitted about a fortnight ago. He made sure I was happy on the day. Asked me how it felt and did I need any changes made. It was fine, but he let me know I could come back if I had any problems."

Staff training was kept up to date so that staff could care for people safely and to an appropriate standard.

We found people were protected from the risk of infection because appropriate guidance had been followed and there was an effective system in place to monitor and assess the quality of the service.