We carried out this announced follow up inspection on 12 September 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 had undertaken an unannounced focused inspection of this service on 7 April 2017 as part of our regulatory functions where breaches of legal requirements were found.

After the focused inspection, the practice wrote to us to say what they would do to meet the legal requirements in relation to each of the breaches.

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

We revisited Manchester Dental as part of this review and checked whether they had followed their action plan and to confirm that they now met the legal requirements. We checked these areas as part of this follow-up comprehensive inspection and found this had been resolved.

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 providing well-led care in accordance with the relevant regulations.

Background

Manchester Dental is located in Urmston, Manchester and provides private treatment to adults and children. The practice also offers private orthodontic treatment, dental implants, occasional intravenous sedation and cosmetic treatments. A chiropodist operates alongside the service but this does not come under our regulation.

There is access for people who use wheelchairs and pushchairs. Car parking spaces, including for patients with disabled badges, are available at the practice with additional on-street parking available.

The dental team includes three dentists, four dental nurses (one of which is a trainee), two dental hygiene therapists and a practice manager. The practice has two 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 Manchester Dental was the principal dentist.

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

The practice is open from 9am to 6pm Monday, Wednesday and Friday, 9am to 8pm Tuesday, 9am to 5pm Thursday and 9am to 4pm Saturday.

On the day of inspection we reviewed patient feedback and spoke with three patients. This information gave us a positive view of the practice.

Our key findings were:

• The practice was clean and well maintained.
• The practice had infection control procedures which reflected published guidance.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• The practice had systems to help them manage risk.
• The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• The practice had thorough staff recruitment procedures.
• 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.

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

• Review the practice’s arrangements for receiving and responding to patient safety alerts, recalls and rapid response reports issued from the Medicines and Healthcare products Regulatory Agency (MHRA) and through the Central Alerting System (CAS), as well as from other relevant bodies such as, Public Health England (PHE).

• Review the practice’s safeguarding staff training; ensuring it covers both children and adults and all staff are trained to an appropriate level for their role.

• Review the practice’s arrangements for conscious sedation, ensuring staff involved with this service are aware of roles and responsibilities, giving due regard to 2015 guidelines published by The Intercollegiate Advisory Committee on Sedation in Dentistry in the document 'Standards for Conscious Sedation in the Provision of Dental Care 2015.

We carried out this unannounced inspection on 7 April 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 second inspector.

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?

On this occasion we inspected as a result of information of concern. We focused on the safe and well led questions.

Our findings were:

Are services safe?

We found that this practice was not providing safe 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

Manchester Dental is located in Urmston, Manchester and provides private treatment to adults and children. The practice also offers private orthodontic treatment, dental implants, intravenous sedation and cosmetic treatments. A chiropodist operates alongside the service but this does not come under our regulation.

There is access for people who use wheelchairs and pushchairs. Car parking spaces, including for patients with disabled badges, are available at the practice with additional on-street parking available.

The dental team includes three dentists, six part time dental nurses and two dental hygiene Therapists. The practice has two 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 Manchester Dental was the principal dentist.

During the inspection we spoke with the principal dentist, two dental nurses, one of whom was an agency nurse and the practice manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open from 9am to 6pm Monday, Wednesday and Friday, 9am to 8pm Tuesday, 9am to 5pm Thursday and 9am to 4pm Saturday.

Our key findings were:

• The practice did not have infection control procedures which reflected published guidance.
• Staff knew how to deal with emergencies. Emergency medicines and life-saving equipment were available but some of these had expired.
• The practice was working to improve systems to help them manage risk.
• The practice had safeguarding processes and staff knew how to report their concerns but up to date safeguarding training had not been provided.
• Staff recruitment procedures were insufficient.
• There had been a change in the leadership arrangements for the practice and they were working to improve policies and procedures.

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

• Ensure staff are up to date with their mandatory training and their Continuing Professional Development (CPD).
• Ensure that all staff have undergone relevant training, to an appropriate level, in the safeguarding of children and vulnerable adults.
• 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’.
• Ensure the practice's recruitment policy and procedures are suitable and the recruitment arrangements are in line with Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 to ensure necessary employment checks are in place for all staff and the required specified information in respect of persons employed by the practice is held. This includes ensuring checks are in place for agency staff.
• Ensure that the practice is in compliance with its legal obligations under Ionising Radiation Regulations (IRR) 99 and Ionising Radiation (Medical Exposure) Regulation (IRMER) 2000.
• Ensure systems are put in place for the proper and safe management of medicines.
• Ensure an effective system is established to assess, monitor and mitigate the various risks arising from undertaking of the regulated activities.
• Ensure the practice’s audit protocols of various aspects of the service, such as radiography and infection prevention and control are reviewed at regular intervals to help improve the quality of service. Practice should also check all audits have documented learning points and the resulting improvements can be demonstrated.
• Ensure the practice responsibilities and storage with 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.

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:

• Review the practice’s arrangements for receiving and responding to patient safety alerts, recalls and rapid response reports issued from the Medicines and Healthcare products Regulatory Agency (MHRA) and through the Central Alerting System (CAS), as well as from other relevant bodies such as, Public Health England (PHE).
• Review the practice’s system for the recording, investigating and reviewing incidents or significant events with a view to preventing further occurrences and, ensuring that improvements are made as a result.
• Review availability of medicines and equipment to manage medical emergencies giving due regard to guidelines issued by the Resuscitation Council (UK), and the General Dental Council (GDC) standards for the dental team.
• Review the storage of dental care products and medicines requiring refrigeration to ensure they are stored in line with the manufacturer’s guidance and the fridge temperature is monitored and recorded and review the process to identify and dispose of out-of-date stock.
• Review the practice’s sharps procedures giving due regard to the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.

We visited Manchester Dental 21 November 2013 and saw all areas were clean and tidy. There was a practice information folder and posters in the waiting room offering advice and information about the service.

Staff made efforts to ensure patients' privacy and dignity was maintained. Patient feedback was regularly gathered and the information analysed and issues raised were addressed.

We saw a sample of patient records, which contained up to date medical information. Discussions with patients around treatment options were thorough and patients were given time to make an informed decision.

We spoke with three patients. One told us, “They are very obliging and fit you in as soon as possible. It is a very pleasant atmosphere; from the dentist to the receptionist they are very pleasant”. Another told us, “They were very thorough. It’s the best thing I ever did”.

There were lead members of staff for the areas of safeguarding and infection control. We spoke with two members of staff who demonstrated an understanding of safeguarding processes and capacity issues

Policies and procedures were accessible to staff and emergency medical equipment was in place. Decontamination processes were followed and hygiene procedures adhered to, minimising the risk of cross infection.

There was an up to date complaints procedure and a number of audits were regularly undertaken and the results acted upon when necessary.