We carried out an unannounced comprehensive inspection of this practice on 21 January. Breaches of legal requirement were found. After the comprehensive inspection, the practice wrote to us to say what they would do to meet legal requirements in relation to the breaches.

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 M Verma & S Verma Abacus Dental Care on our website at www.cqc.org.uk

Our findings were:

Are services well-led?

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

Background

M Verma & S Verma Abacus Dental Care is a general dental practice in the Crownhill area of Milton Keynes. The practice provides NHS and private general dentistry to adults and children.

In addition to a full range of general dentistry, a visiting dentist to the practice offers dental implants (a metal post placed surgically into the jaw bone that can be used to support a single tooth, a bridge or denture). This treatment can be carried out under conscious sedation (techniques in which the use of a drug or drugs produces a state of depression of the central nervous system enabling treatment to be carried out, but during which verbal contact with the patient is maintained throughout the period of sedation).

The premises are over two floors and consist of a waiting area, treatment room and office on the ground floor, and further waiting room, two treatment rooms and decontamination room on the first floor, although one of the treatment rooms was not in use at the time of our visit.

The practice is open from 8.30am to 5.00pm Monday, Wednesday, Thursday and Friday; from 6.00pm to 8.00pm on a Tuesday evening and alternate Saturday mornings from 9.00am to 1.00pm.

The principal dentist 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.

Our key findings were:

• The practice had overhauled the governance procedures and staff were actively engaged in the improvement and maintenance of the practice.

• Policies were updated and arranged in a way that staff could access easily.

• Clinical audit was used as a tool to highlight areas where improvements could be made, and effect those improvements.

• Dental care records were found to be comprehensive, and improvements had been highlighted and noted through the detailed clinical record keeping audit.

We carried out an unannounced comprehensive inspection on 21 January 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 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

M Verma & S Verma Abacus Dental Care is a husband and wife dental team that have taken over the site in the Crownhill area of Milton Keynes one year ago. The practice provides NHS and private general dentistry to adults and children.

In addition to a full range of general dentistry, a visiting dentist to the practice offers dental implants (a metal post placed surgically into the jaw bone that can be used to support a single tooth, a bridge or denture). This treatment can be carried out under conscious sedation (techniques in which the use of a drug or drugs produces a state of depression of the central nervous system enabling treatment to be carried out, but during which verbal contact with the patient is maintained throughout the period of sedation).

The premises are over two floors and consist of a waiting area, treatment room and office on the ground floor, and further waiting room, two treatment rooms and decontamination room on the first floor, although one of the treatment rooms was not in use at the time of our visit.

The practice is open from 8.30am to 5.00pm Monday, Wednesday, Thursday and Friday. From 6.00pm to 8.00pm on a Tuesday evening and alternate Saturday mornings from 9.00am to 1.00pm.

The principal dentist 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.

During our inspection we spoke with six patients who attended the practice that day. The feedback we received was entirely positive, with all patients commenting that options are always thoroughly explained to them, and they are given ample opportunity to ask questions.

Our key findings were:

• The practice had equipment and medicines for treating medical emergencies in line with the recommendations of the British National Formulary and the Resuscitation Council UK guidance.

• The practice met the essential requirements of the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices, with the exception of six monthly infection control audits, although we have received evidence that an audit has been completed following the inspection.

• Patients to the practice commented that they were always treated with dignity and kindness and treatment options were always explained to them in detail.

• Dental care records were found to lack detail, and evidence that routine screening was undertaken. In addition they were not always written at the time of the appointment.

• Practice policies, although available, were arranged haphazardly. For example, there were multiple policies on the same subject in several folders and some no longer relevant making it difficult for staff to reference information that may be required in the running of the practice and safeguarding of visitors to the practice.

• Action plans from a fire risk assessment and following an inspection of the X-ray machines had not been implemented. Although following the inspection we received information that the fire risk action plans have now been completed.

• A written justification for taking X-rays and a written report of the findings of the X-rays were not always noted in the dental care records. As specified in the Ionising Radiation (Medical Exposure) Regulations 2000.

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

• Ensure effective systems to assess monitor and improve the quality and safety of the service are in place. With specific reference to clinical audits being carried out as a tool to identify areas of concern, and ensuring dental care records are completed giving due regard to guidance provided by the Faculty of General Dental Practice regarding record keeping.

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:

• Continue the programme of improvement of updating the practice policies and arranging them in such a way that staff can find all relevant information easily.

• Review the practice’s protocols and procedures for promoting the maintenance of good oral health giving due regard to guidelines issued by the Department of Health publication ‘Delivering better oral health: an evidence-based toolkit for prevention’

• Review the practice’s infection control procedures and protocols 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 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 staff awareness of the requirements of the Mental Capacity Act (MCA) 2005 and ensure all staff are aware of their responsibilities under the Act as it relates to their role.

• Establish and operate effectively an accessible system for identifying, receiving, recording, handling and responding to complaints by patients.

• Implement a training log with specific reference to the continuing professional development requirements of the general dental council for all dental professionals in the practice.

• Review arrangements to meet the Control of Substances Hazardous to Health guidance.