This inspection was carried out to review in detail the actions taken by the registered provider to improve the quality of care and to confirm that the practice was now meeting legal requirements.

The inspection was led by a CQC inspector.

Previously, we had undertaken a comprehensive inspection on 5 November 2018 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We found the registered provider was not providing well-led care in accordance with the relevant regulations 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 Marford Road Dental Practice on our website www.cqc.org.uk.

When one or more of the five questions are 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.

As part of this inspection we asked:

• Is it well-led?

Background

Marford Road Dental Practice is a well-established practice based in Wheathampstead that provides both NHS and private dental treatment to about 9,000 patients. The dental team includes two dentists, a specialist periodontist, a hygienist, a practice manager, three dental nurses and two reception staff. There are three treatment rooms. There is on-site parking for four cars and additional parking opposite the practice.

The practice opens on Mondays to Fridays from 9am to 5pm.

The practice is owned by a partnership 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 practice has a part-time registered/ compliance manager, who also works at another dental service.

Our findings were:

The provider had made effective improvements in relation to the regulatory breach we found at our previous inspection and was now was providing well-led care in accordance with the relevant regulations. These improvements must be sustained in the long-term.

We carried out this announced inspection on 5 November 2018 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

Marford Road Dental Practice is a well-established practice based in Wheathampstead that provides both NHS and private dental treatment to about 9,000 patients. The dental team includes two dentists, a specialist periodontist, a hygienist, a practice manager, three dental nurses and two reception staff. There are three treatment rooms. There is on-site parking for four cars and additional parking opposite the practice.

The practice opens on Mondays to Fridays from 9am to 5pm.

The practice is owned by a partnership 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 practice has a part-time registered/ compliance manager, who also works at another dental service.

On the day of inspection, we collected 46 CQC comment cards completed by patients. We spoke with a dentist, the practice manager, the registered manager and two nurses.

We looked at practice policies and procedures and other records about how the service is managed.

Our key findings were:

• Information from completed Care Quality Commission comment cards gave us a positive picture of a caring and professional service.
• The practice appeared clean and well maintained.
• The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
• Patients received their care and treatment from well supported staff, who enjoyed their work.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted upon.
• The management of risk was limited and potential hazards within the practice had not been identified or assessed to reduce potential harm.
• The practice’s sharps procedures were not in compliance with the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.

• The quality of recording in patients’ dental care records was variable and did not always take into account guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.
• Staff did not receive regular appraisal of their performance and not all had personal development plans in place.
• Pre-employment checks were not always undertaken to ensure staff were suitable to work with vulnerable adults and children.

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

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care

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

• Review the practice’s responsibilities to meet the needs of people with a disability, including those with hearing difficulties and the requirements of the Equality Act 2010.