We carried out a focused inspection of Marston Green Dental on 27 November 2017.

The inspection was led by a CQC inspector.

We carried out the inspection to follow up concerns we originally identified during a comprehensive inspection at this practice on 7 March 2017 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions.

At a comprehensive inspection we always ask the following five questions to get to the heart of patients’ experiences of care and treatment:

• Is it safe?
• Is it effective?
• Is it caring?
• Is it responsive to people’s needs?
• Is it well-led?

When one or more of the five questions is 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 areas where improvement was required.

At the previous comprehensive inspection we found the registered provider was providing safe, effective, caring and responsive care in accordance with relevant regulations. We judged the practice was not providing well-led care in accordance with Regulation 17(1) 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 Marston Green Dental on our website www.cqc.org.uk.

We also reviewed the key question of safe as we had made recommendations for the provider relating to this key question. We noted that some improvements had been made.

Our findings were:

Are services well-led?

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

The provider had made improvements to put right the shortfalls and deal with the regulatory breach we found at our inspection on 7 March 2017.

There were areas where the provider still could make improvements. They should:

• Review availability of interpreter services for patients who do not speak English as a first language.

We carried out this announced inspection on 7 March 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. They did not provide any information.

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

Marston Green Dental is in East Birmingham and provides NHS and private treatment to patients of all ages.

There is level access 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, five dental nurses (three of whom are trainees), three dental hygienists and one receptionist. The practice has four treatment rooms.

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 registered manager at Marston Green Dental was the practice manager.

On the day of inspection we collected 21 CQC comment cards filled in by patients and spoke with three other patients. This information gave us a positive view of the practice although some patients commented on high staff turnover at the practice.

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

The practice is open:

Monday-Friday 8:30am – 5:30pm and on Saturday 9am – 1pm.

Our key findings were:

• The practice was visibly clean but some improvements were required with respect to the flooring and walls in clinical areas. Some drawers and cupboards required de-cluttering.
• The practice had infection control procedures which reflected published guidance. Some necessary improvements were required.
• The system to manage safety alerts was not effective.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available. Some items were missing on the day but these were replaced promptly.
• The practice had systems to help them manage risk but improvements were required.
• The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• The practice had staff recruitment procedures but some documentation was missing.
• There was limited evidence relating to training and Continuing Professional Development (CPD) of staff.
• 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:

• Ensure an effective system is established to assess, monitor and mitigate the various risks arising from undertaking of the regulated activities. This includes ensuring the availability of medicines and equipment to manage medical emergencies giving due regard to guidelines issued by the British National Formulary, the Resuscitation Council (UK) and the General Dental Council (GDC) standards for the dental team.

• Ensure the practice’s infection control procedures and protocols are suitable taking into account guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices and giving due regard toThe 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.

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 its audit protocols to document, where applicable the learning points, that are shared with all relevant staff and ensure that the resulting improvements can be demonstrated as part of the audit process.
• Review their procedures for monitoring patients during sedation and consider the use of a pulse oximeter to monitor the patient’s vital signs.