We carried out a follow-up inspection of this practice on 21 February 2017.

We had undertaken an announced comprehensive inspection of this service on 17 March 2016 as part of our regulatory functions. During that inspection breaches of legal requirements were found. You can read the report from the comprehensive inspection, by selecting the 'all reports' link for Menlove Dental Practice on our website at www.cqc.org.uk.

After the comprehensive inspection, the registered provider sent us an action plan to say what they would do to meet the legal requirements in relation to each of the breaches. This report only covers our findings in relation to those requirements.

We reviewed the practice against one of the five key questions we ask about services: is the service well led? We revisited Menlove Dental Practice as part of this review to check whether they had followed their action plan and to confirm that they now met the legal requirements.

Our findings were:

Are services well-led?

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

Background

Menlove Dental Practice is located in a residential suburb of Liverpool. The practice comprises a reception, waiting room and two treatment rooms on the ground floor, and three treatment rooms, a decontamination room and an X-ray room on the first floor. Parking is available nearby. The practice is accessible to patients with disabilities, mobility difficulties and to wheelchair users.

The practice provides general dental treatment to patients of all ages on an NHS or privately funded basis.

The practice is open Monday to Thursday 9.00am to 5.30pm and Friday 9.00am to 4.30pm and is staffed by a practice manager, six dentists, three dental hygienists, four receptionists, one of whom is a trainee, and ten dental nurses, two of whom are trainees.

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 provider had put in place procedures in place to record, analyse and learn from significant events and incidents.
• The premises and equipment were clean and well maintained.
• Staff were supported to deliver effective care, and monitoring to ensure staff were up to date with essential training was now in place.
• Governance arrangements had been improved, including improvements to systems and risk assessments.

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

• Review the practice’s sharps handling procedures and protocols to ensure compliance with the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.
• Review the practice's recruitment policy and procedures to ensure the prescribed information is requested and available.
• Review the practice’s audit protocols and ensure audits, such as radiology are undertaken at regular intervals to help improve the quality of service. The provider should also check all audits have documented learning points which are shared with staff and the resulting improvements can be demonstrated.
• Review methods to support communication to all staff about the quality and safety of the service.

We carried out an announced comprehensive inspection on 17 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 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

Menlove Dental Practice is located in a residential suburb and comprises a reception, waiting room, two treatment rooms, an office and staff room on the ground floor, and three treatment rooms, a decontamination room and an X-ray room on the first floor. Parking is available on nearby streets. The practice is accessible to patients with disabilities, impaired mobility and to wheelchair users.

The practice provides general dental treatment to patients of all ages on an NHS or private basis.

The practice is open Monday to Thursday 9.00am to 5.30pm and Friday 9.00am to 4.30pm and is staffed by a practice manager, six dentists, three hygienists, four receptionists, one of whom is a trainee, and ten dental nurses, two of whom are trainees.

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.

We received feedback from 47 people on CQC comment cards and spoke to four patients during the inspection about the services provided. Every comment was positive about the staff and the service. Patients commented that they found the staff efficient, helpful, kind and and caring. They said that they were always given good explanations about dental treatment and that dentists listened to them.

Our key findings were:

• There was a sufficient number of suitably qualified staff to meet the needs of patients.
• Staff had been trained to deal with medical emergencies and the recommended emergency medicines and equipment were available and appropriately monitored.
• Staff had received safeguarding training and knew the process to follow to raise any concerns.
• Patients’ needs were assessed and care and treatment were delivered in accordance with current legislation, standards and guidance.
• Patients received explanations about their proposed treatment, costs, benefits and risks and were involved in making decisions about it.
• Patients were treated with kindness, dignity and respect and their confidentiality was maintained.
• Patients commented that they were always able to obtain routine and emergency appointments and waiting times were kept to a minimum.
• Services were planned and delivered to meet the needs of patients and reasonable adjustments were made to enable patients to receive their care and treatment.
• The practice had a formal system in place to actively seek the views of people using the service and used this feedback to help them improve.
• The practice recorded accidents and complaints but did not record and analyse significant events.
• The practice received safety alerts but we did not see evidence of action taken in relation to these.
• Improvements were needed to the general condition and cleanliness of the practice.
• Dental X-ray equipment had not been tested within the recommended time interval and one X-ray machine was damaged.
• Some staff lacked training for undertaking their roles and support with professional development.
• Governance systems and processes were in place for the running of the practice; however several were inadequate or were not operating effectively.
• Policies, procedures and risk assessments were not reviewed and updated in line with current legislation and guidance.
• The provider did not share learning from complaints, events, concerns and audits to encourage improvement.

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

• Ensure that the practice is in compliance with its legal obligations under the Ionising Radiation Regulations 1999 and the Ionising Radiation (Medical Exposure) Regulations 2000 in relation to the maintenance and testing of X-ray equipment.
• Ensure the practice’s infection control procedures and protocols are suitable having 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, in relation to maintaining standards of hygiene appropriate for the service.
• Ensure systems or processes are established and operated effectively to ensure compliance with regulations 4 to 20A of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, specifically in relation to systems for recording of significant events, cleaning, recruitment, reviews of policies and risk assessments. The provider must also ensure systems are established to evaluate and improve the service.

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

• Review the training, learning and development needs of individual staff members and establish an effective process for the on-going assessment and supervision of all staff.
• Review methods to support communication to staff about the quality and safety of services.
• Review the recording of complaints to ensure verbal complaints are captured and actions and learning points are recorded.
• Implement an archived paper records storage facility which meets health and safety and fire regulations in accordance with the Department of Health’s code of practice for records management (NHS Code of Practice 2006) and other relevant guidance about information security and governance.

We spoke with three patients during our visit and they told us they were happy with the service. People told us they visited the dentist on a regular basis and their dentist had always explained what they were doing, what they had found during examination and what the treatment options had been, including risks and benefits. Patients told us they received reminders to book a check-up appointment every six months and they told us they had been able to get appointments at short notice if they needed this. People’s comments included: “I’ve been coming here a long time and they’re very good” and “I have every confidence in my dentist and I trust him.”

All parts of the practice which we viewed were clean and tidy and we saw equipment was appropriately stored and labelled. Appropriate infection control practices were in place and regular checks on cleanliness and hygiene practices had been carried out.

Policies and procedures for safeguarding children and adults were in place and staff had been provided with training in safeguarding.

New staff were only recruited when appropriate pre-employment checks had been carried out. These were carried out to ensure staff were appropriately skilled, qualified and experienced to carry out their role.

We carried out this announced inspection on 26 April 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 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 providing well-led care in accordance with the relevant regulations.

Background

Menlove Dental Surgery is in a residential suburb of Liverpool and provides NHS and private dental care and treatment for patients of all ages.

The provider has installed a ramp to facilitate access to the practice for wheelchair users. Car parking is available near the practice.

The dental team includes a principal dentist, five associate dentists, 10 dental nurses, four of whom are trainees, three dental hygiene therapists, and four receptionists, one of whom is a trainee. The team is supported by a practice manager. The practice has six 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 Menlove Dental Surgery was the principal dentist.

We received feedback from 23 people during the inspection about the services provided. The feedback provided was mainly positive about the practice.

During the inspection we spoke to two dentists, dental nurses, a dental hygiene therapist, receptionists and the practice manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday to Friday 9.05am to 5.40pm.

Our key findings were:

• The practice was clean and well maintained.
• Staff knew how to deal with medical emergencies. Appropriate medicines and equipment were available.
• The provider had systems in place to manage risk.
• The provider had safeguarding procedures in place and staff knew their responsibilities for safeguarding adults and children.
• 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 dental team provided preventive care and supported patients to achieve better oral health.
• The appointment system took account of patients’ needs.
• The provider had a procedure in place for dealing with complaints. The practice dealt with complaints positively and efficiently.
• The practice had a leadership and management structure in place.
• Staff felt involved and supported and worked well as a team.
• The practice asked patients and staff for feedback about the services they provided.
• The provider had information governance arrangements in place.
• The practice had infection control procedures in place which mostly reflected published guidance.
• The provider had staff recruitment procedures in place. Not all the recruitment checks were carried out for the clinicians.

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

• Review the practice’s infection control procedures and protocols taking into account the guidelines issued by the Department of Health in the Health Technical Memorandum 01-05: Decontamination in primary care dental practices, and having regard to The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance’, in particular, review the use of sticky tape on dental instruments, uncovered instruments in drawers, and whether the automatic control test on the autoclaves has successfully completed.
• Review the practice's recruitment procedures to ensure that appropriate checks are completed prior to all new staff commencing employment at the practice.
• Review the practice's protocols and procedures to ensure staff are up to date with their mandatory training and their continuing professional development.