We carried out a focused inspection of Moreton Dental on 9 October 2017.

The inspection was led by a CQC inspector who was supported by a specialist dental adviser.

We carried out the inspection to follow up concerns we originally identified during a comprehensive inspection at this practice on 23 January 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 Regulation17 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 Moreton Dental on our website www.cqc.org.uk.

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 breaches we found at our inspection on 23 January 2017.

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

The provider had made sufficient improvements to put right the shortfalls and had dealt with the regulatory breaches we found at our inspection on 23 January 2017.

We carried out this announced inspection on 23 January 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 advisor.

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 this practice was providing safe care in accordance with the relevant regulations.

Are services effective?

We found this practice was providing effective care in accordance with the relevant regulations.

Are services caring?

We found this practice was providing caring services in accordance with the relevant regulations.

Are services responsive?

We found this practice was providing responsive care in accordance with the relevant regulations.

Are services well-led?

We found this practice was not providing well-led care in accordance with the relevant regulations.

Background

Moreton Dental is in Moreton-in-Marsh and close to the town centre. It provides private treatment to patients of all ages.

There is level access for people who use wheelchairs and pushchairs. Car parking spaces are available near the practice. There is a local bus service directly outside the practice.

The dental team includes the principal dentist, one dental hygienist, one qualified dental nurse/ receptionist and one trainee dental nurse. The practice has one treatment room.

The practice is owned by an individual who is the principal dentist there. They have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run.

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.

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

The practice is open: Monday – Friday 9.00am – 5.00pm. The practice operates an out-of-hours emergency service available until 9.00pm during weekdays and 9.00am-5.00pm Saturdays and Sundays. Details of the call out fees are on the website.

Our key findings were:

• The practice was clean and well maintained.
• The practice had infection control procedures which did not wholly reflect published guidance.
• Staff knew how to deal with emergencies but not all recommended life-saving equipment and medicines were available.
• The practice had some systems to help them manage risk but they were not operated effectively.
• The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• The practice staff recruitment procedures were not thorough and did not fully meet the regulatory requirements.
• 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 limited leadership with some governance systems but they were not operated effectively.
• Staff felt involved, 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.
• Few formal audits had been undertaken to assess and monitor the service and to identify improvements which could be made to enhance the service.

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

• Ensure the proper and safe management of emergency equipment and medicines.
• Ensure systems and process to manage infection prevention and control follow current legislative guidance including environmental cleaning.
• Ensure risks relating to health and safety and welfare are assessed monitored and mitigated where possible in accordance with current guidance and legislation.
• Ensure systems and processes are effectively operated to assess, monitor and improve the quality and safety of services provided.
• Ensure records relating to the management of regulated activities are maintained and stored in accordance with record keeping guidance.
• Ensure all required checks are completed in accordance with legislation prior to staff commencing work in the practice.

Full details of the regulations the provider was not meeting are at the end of this report.