We undertook a focused inspection of Moss Grove dental practice on Wednesday 8 August 2018. 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 who had access to telephone support by a specialist dental adviser.

We undertook a comprehensive inspection of Moss Grove dental practice 9 January 2017 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 Moss Grove 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?

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 in relation to the regulatory breach we found at our inspection on 9 January 2017.

Background

Moss Grove is in Kingswinford and provides private treatment to adults and children.

There is ramp access for people who use wheelchairs and those with pushchairs. The practice has a car park and other car parking spaces, including for blue badge holders, are available near the practice.

The dental team includes two dentists, four dental nurses and a practice manager. Dental nurses also work as receptionists. The practice has three treatment rooms, all of which are on the ground floor.

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.

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

The practice is open: Monday to Friday 9am to 12.30pm and 2pm to 5.30pm with extended hours opening on a Monday until 7pm. The practice is also open by appointment only once a month on a Saturday between 9am and 12 noon.

Our key findings were:

• The practice had systems for the disposal of amalgam waste in accordance with HTM 01-07.
• Items subject to the Control of Substances Hazardous to Health were securely stored.
• The practice’s fire safety equipment was serviced, checked and maintained in good working order. Staff completed six monthly fire drills.
• The provider had completed training regarding how to complete a legionella risk assessment and had completed a risk assessment for the practice.
• Suitable systems were in place for the recording, investigating and reviewing accidents or significant events.
• The practice was giving due regard to the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.
• The practice was giving due regard to the Ionising Radiation (Medical Exposure) Regulations (IR(ME)R) 2000 regulation.
• The practice’s complaint procedure included contact details for external organisations for patients to contact if they are unhappy with the outcome of the practice’s internal investigation. The patient information leaflet also recorded these contact details.
• The practice had reviewed its responsibilities to the needs of people with a disability and the requirements of the Equality Act 2010. A hearing loop had been purchased and contact details for sign language interpreters have been made available for staff. The practice manager had prepared information for staff regarding the accessible information standards. Information was available for staff regarding how to communicate with people who were hearing impaired. The practice did not have an accessible toilet and due to the constraints of the building would not be able to provide one. We were told that new patients would be informed of this.

We carried out an announced comprehensive inspection on 9 January 2017 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

Moss Grove Dental Practice has a principal dentist and one associate dentist, a part time practice manager and four qualified dental nurses who are registered with the General Dental Council (GDC). The practice’s opening hours are 9am to 5.30pm on Monday to Friday with extended opening hours until 7pm for pre-booked appointments only each Monday. The practice is also open for two Saturdays each month between 9am and 12pm.

Moss Grove Dental Practice provides private dental treatment for adults and children. The practice has three dental treatment rooms on the ground floor. There is a separate decontamination room for cleaning, sterilising and packing dental instruments. There is also a reception, waiting area and patient toilet on the ground floor.

Before the inspection we sent Care Quality Commission comments cards to the practice for patients to complete to tell us about their experience of the practice and during the inspection we spoke with patients. We received feedback from 46 patients who provided a positive view of the services the practice provides. All of the patients commented that the quality of care was very good and staff were friendly and helpful.

Our key findings were

• Systems in place for the recording and learning from significant events, accidents and safety alerts were not robust.
• There were sufficient numbers of suitably qualified staff to meet the needs of patients.
• Patients were treated with dignity and respect.
• The practice was visibly clean and well maintained.
• Infection control procedures in place were not robust, staff were re-using some single use items, the practice’s infection prevention and control audits were not robust as they had not identified some issues highlighted during this inspection and some equipment used in the decontamination process had previously passed its service interval.
• Emergency equipment for dealing with medical emergencies reflected published guidelines. Staff had completed annual update training regarding dealing with medical emergencies.
• The appointment system met the needs of patients and waiting times were kept to a minimum.
• There was no evidence that the practice had carried out an assessment of risk, for example an audit regarding radiography.
• We identified regulations that were not being met and the provider must:

• The provider had not ensured that risks to the health and safety of people using the service had been mitigated by ensuring that suitable fire safety procedures and protocols with robust processes to provide assurance that all fire safety equipment is serviced, checked and maintained in good working order had been implemented.
• The undertaking of a legionella risk assessment by a competent person and assuring the suitability of the practice’s infection control procedures and protocols, the provider must have regard to The Health and Social Care Act 2008: ‘Code of Practice’.
• The implementation of robust systems for the recording, investigating and reviewing of accidents or significant events.
• Establishing processes to ensure staff work in accordance with the practice sharps procedure on all occasions giving due regard to the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.
• Compliance with waste disposal procedures outlined in HTM 01-07 particularly regarding the disposal of amalgam waste.
• Secure and safe storage of items subject to the Control of Substances Hazardous to Health.
• The provider must have regarding to Ionising Radiation (Medical Exposure) Regulations (IR(ME)R) 2000 regulation. For example, establishing protocols for recording the reason for taking X-rays, the completion of regular X-ray audits.

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

• Review the practice’s complaint procedure to ensure patients have contact details for external organisations to contact if they are unhappy with the outcome of the practice’s internal investigation.
• Review the practice’s responsibilities to the needs of people with a disability and the requirements of the Equality Act 2010 and ensure an Equality Act audit is undertaken for the premises.
• Review the practice’s procedures regarding the undertaking and recording of fire drills to ensure that all staff complete fire drills on a regular basis.

This practice is located on the ground floor and is accessible to people who have restricted mobility. The premises consisted of a reception area, waiting room, two treatment rooms, decontamination room and toilet.

The dental team consisted of two dentists, four dental nurses and a practice manager. All the dental professionals were registered with the General Dental Council.

We found that people were informed of their treatment options and their consent for treatment was obtained. One person who used the service said, "My dentist always tells me what needs to be done and the benefits.”

Dental records contained relevant information about people’s dental treatment and their medical history.

We found that the decontamination process for dental instruments was satisfactory to reduce the risk of cross infection.

A risk assessment was in place to ensure that all staff were suitable to work at the practice. One person who used the service told us, “All the staff are very good and polite, I’m so happy with the service they provide.”

People had access to a complaints procedure and we found that complaints were managed appropriately.