On 7th November 2013 we found that there were no systems in place to identify, assess and manage risks to the health, safety and welfare of people who used the service and others.

We returned to the service to undertake a follow up visit on 24th June 2014 and found that systems continued to fall short of requirements that ensured patient safety and welfare was maintained. For that reason we issued the provider with a warning notice which required them to become compliant with Regulation 10 of the Health and Social Care Act (2008), by 28th August 2014. The requirements of compliance included appropriate staff training, documented staff meetings, appraisals for staff, audits to assess risks in the environment and processes to obtain feedback from patients.

On 8th September 2014 we revisited the practice to see what progress the provider had made. We spoke with the practice manager and reviewed documentation which evidenced that audits had been carried out, staff meetings had been attended, staff training and appraisals had taken place and patient feedback had been obtained. The provider may find it useful to note that not all staff spoken with were aware of HTM-01-05 guidance. HTM-01-05 is designed to assist all registered primary dental care services to meet satisfactory levels of decontamination.

Staff we spoke with told us the practice felt “more organised” and “audits and training had identified areas where we could do things better such as hygiene and correct cleaning of instruments”. We saw that the provider’s self-assessment of infection control had identified that a new dental chair was required and this was due to be delivered in October 2014. The provider agreed that an independent infection control assessment would be beneficial for the practice and would be arranged as soon as possible.

Patients we spoke with said “This dentist is great”, “This is my first visit and so far it’s all been fine” and “My whole family have been coming here for years and I wouldn’t consider going anywhere else”.

Our inspection of 7th November found that there were no systems in place to identify, assess and manage risks to the health safety and welfare of people who used the service and others. The provider was not monitoring the quality of the service or proactively obtaining feedback from patients. The provider wrote to us in January 2014 and told us they would rectify the issues we had found. We went back to inspect the practice to check if improvements had been made.

There were four employees at the practice including the provider who was the lead dentist, a dental nurse and a trainee dentist. There was a temporary practice manager who also covered as a receptionist. We spoke with the provider and the temporary practice manager.

We reviewed the provider's action plan before the visit. The plan stated that systems would be put in place to rectify the deficiencies found at our inspection on 7th November 2013. The provider told us they would undertake staff meetings and document the discussions which took place. They said they would conduct staff appraisals and they would undertake patient surveys and carry out audits. These actions would ensure that people who used the service were protected against risks associated with the service provided. The provider was unable to evidence that these actions had been undertaken to a level which would protect patients or others from risks associated with the service provided. No systems were in place to obtain feedback from people who used the service.

Structural improvements had been carried out to the building and a dedicated decontamination room was now in use. The practice manager demonstrated the procedure to carry out decontamination according to HTM-01-05 guidance. HTM-01-5 is designed to assist all registered primary dental care services to meet satisfactory levels of decontamination. However the provider could not evidence that checks were being undertaken to ensure that this guidance was being followed and there were no written instructions displayed which explained the decontamination process. There were no checks undertaken to ensure that a structured cleaning regime was being carried out on a daily basis.

There was a small reception area and a waiting room. We saw a range of health promotional leaflets and posters in the waiting room and there was a range of oral hygiene products available for patients to purchase.

We saw that costs and treatment options were discussed with patients. We saw the dentist carried out an examination of hard and soft tissue to check for abnormalities.

The patients we spoke with told us: “The dentist is really nice.” “I don’t have any concerns.” “I am never kept waiting too long.” “It is fairly easy to get an appointment perhaps not the same day but you don’t wait too long.” “I am happy with the service.” “The staff are very nice.” “The dentist explains what he is going to do.”

We observed that acceptable practices for the decontamination and sterilisation processes were undertaken as per HTM01-05 requirements.

We found there were no systems in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others.