We carried out an announced comprehensive inspection on 8 December 2015 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 this practice was not 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

Peasedown Dental Practice is a very small building with two dental treatment rooms and a waiting/ reception area located in the village of Peasedown St John, near Bath. It provides general dentistry, including endodontics and restorative services, to NHS patients, but will also treat private patients. The split is approximately 80% NHS and 20% private treatments The service has two treatment rooms and treats both adults and children.

The practice has two dentists and a locum dentist, who covers for one of the dentists when they are not in the practice, two qualified dental nurses and a trainee dental nurse; a practice manager and two part time receptionists. There is no registered manager at the practice. 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.

The practice is open Monday to Thursday from 8.45am until 1.00pm and 2.00pm until 5.00pm; Friday 08.45am -1.00pm only. The practice is closed at weekends.

We reviewed 14 CQC comment cards that had been left for patients to complete, prior to our visit, about the services provided. In addition we spoke with nine patients on the day of our inspection. Feedback from patients was positive about the care they received from the practice. They commented staff put them at ease, listened to their concerns and they had confidence in the dental services provided.

Our key findings were:

• The practice carried out oral health assessments and planned treatment in line with current best practice guidance, for example from the Faculty of General Dental Practice (FGDP). Patient dental care records were detailed and showed on-going monitoring of patients oral health.

• There were systems in place to help ensure the safety of staff and patients with regard to safeguarding children and adults from abuse, maintaining the required standards of infection prevention and control and responding to medical emergencies. However there were ineffective systems to manage the safety of staff and patients in the premises and from equipment used.

• Staff were supported to maintain their continuing professional development; had undertaken training appropriate to their roles. However they did not feel well supported in their work.

• Patients commented they felt involved in their treatment and that it was fully explained to them. We reviewed 14 CQC comment cards completed by patients. Common themes were patients felt they received very good care in a clean environment from a helpful practice team.

• The practice had an efficient appointment system in place to respond to patient’s needs. Patients were able to make routine and emergency appointments when needed. There were clear instructions for patients regarding out of hours care.

• The dental practice had effective clinical governance and risk management processes in place; including health and safety and the management of medical emergencies.

• The practice had a comprehensive system to monitor and continually improve the quality of the service through a detailed programme of clinical and non-clinical audits. However the practice manager told us they had not been given access by the provider to take action to mitigate the identified areas of risk in relation to equipment and environmental improvements.

• The practice had an accessible and visible leadership team with clear means of sharing information with staff.

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 in a timely way.

• Ensure the training, learning and development needs of staff members are reviewed at appropriate intervals and an effective process is established for the on-going assessment and supervision of all staff employed.

We carried out an announced responsive follow up inspection on 23 November 2016 to ask the practice the following key questions; Are services safe and are they well-led?

Our findings were:

Are services safe?

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

Are services well-led?

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

Background

Peasedown Dental Practice is a very small building with two dental treatment rooms and a waiting/ reception area located in the village of Peasedown St John, near Bath. It provides general dentistry, including endodontics and restorative services, to NHS patients, but will also treat private patients. The service has two treatment rooms and treats both adults and children.

The practice has two dentists and two locum dentists, who cover for one of the dentists when they are not in the practice, four qualified dental nurses; a practice manager and two part time receptionists.

There was a practice manager in post who is in the process of applying to become 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.

The practice is open Monday to Thursday from 8.45am until 1.00pm and 2.00pm until 5.00pm; Friday 08.45am -1.00pm only.

Since the last inspection the practice had been refurbished throughout to address the environmental and risk areas. The provider had also appointed a new practice manager who had implemented governance systems and processes and worked with the provider to improve the management of the service.

At the last inspection we found the practice was non-compliant and had issued them with requirement notices in respect of staffing and good governance.

We carried out an announced responsive follow up inspection on 23 November 2016 to check the provider had taken action to address the areas of non-compliance and was now providing a safe and quality monitored service. The inspection took place over one day and was carried out by a lead inspector with remote specialist dental advice.

We obtained feedback about the practice from three patients we spoke with during the inspection. The patients we spoke with were very complimentary about the service. They told us they liked the newly decorated practice and staff changes. They reported they had experienced good care from friendly and welcoming staff and felt they were treated with dignity and respect.

Our key findings were:

• The patients we spoke with indicated they were treated with kindness and respect by staff and received good care in a clean environment from a helpful practice team. We observed good communication with patients and their families.

• Premises appeared well maintained and visibly clean. Good cleaning and infection control systems were in place. The treatment rooms were well organised and equipped, with good light and ventilation

• The practice was meeting the Essential Quality Requirements of the Department of Health guidance, namely 'Health Technical Memorandum 01-05 - Decontamination in primary care dental practices (HTM 01-05)' national guidance for infection prevention control in dental practices.

• The dental practice had effective clinical governance and risk management processes in place; including health and safety and the management of medical emergencies. There were systems in place to learn and improve from incidents or healthcare alerts.

• The practice had a comprehensive system to monitor and continually improve the quality of the service; including through a detailed programme of clinical and non-clinical audits.

• There were systems in place to check all equipment had been serviced regularly, including the air compressor, autoclave, fire extinguishers, oxygen cylinder and the X-ray equipment.

• Appropriate recruitment processes and checks were undertaken in line with the relevant recruitment regulations and guidance for the protection of patients.

• There were sufficient numbers of suitably qualified staff who maintained the necessary skills and competence to support the needs of patients.

• Staff were supported to maintain their continuing professional development; had undertaken training appropriate to their roles and felt supported in their work.

• The practice had a new proactive practice manager who provided accessible and visible leadership and clear means of sharing information with staff. Staff were up to date with current guidelines and supported in their professional development.

We carried out an announced comprehensive inspection on 8 December 2015 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 this practice was not 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

Peasedown Dental Practice is a very small building with two dental treatment rooms and a waiting/ reception area located in the village of Peasedown St John, near Bath. It provides general dentistry, including endodontics and restorative services, to NHS patients, but will also treat private patients. The split is approximately 80% NHS and 20% private treatments The service has two treatment rooms and treats both adults and children.

The practice has two dentists and a locum dentist, who covers for one of the dentists when they are not in the practice, two qualified dental nurses and a trainee dental nurse; a practice manager and two part time receptionists. There is no registered manager at the practice. 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.

The practice is open Monday to Thursday from 8.45am until 1.00pm and 2.00pm until 5.00pm; Friday 08.45am -1.00pm only. The practice is closed at weekends.

We reviewed 14 CQC comment cards that had been left for patients to complete, prior to our visit, about the services provided. In addition we spoke with nine patients on the day of our inspection. Feedback from patients was positive about the care they received from the practice. They commented staff put them at ease, listened to their concerns and they had confidence in the dental services provided.

Our key findings were:

• The practice carried out oral health assessments and planned treatment in line with current best practice guidance, for example from the Faculty of General Dental Practice (FGDP). Patient dental care records were detailed and showed on-going monitoring of patients oral health.

• There were systems in place to help ensure the safety of staff and patients with regard to safeguarding children and adults from abuse, maintaining the required standards of infection prevention and control and responding to medical emergencies. However there were ineffective systems to manage the safety of staff and patients in the premises and from equipment used.

• Staff were supported to maintain their continuing professional development; had undertaken training appropriate to their roles. However they did not feel well supported in their work.

• Patients commented they felt involved in their treatment and that it was fully explained to them. We reviewed 14 CQC comment cards completed by patients. Common themes were patients felt they received very good care in a clean environment from a helpful practice team.

• The practice had an efficient appointment system in place to respond to patient’s needs. Patients were able to make routine and emergency appointments when needed. There were clear instructions for patients regarding out of hours care.

• The dental practice had effective clinical governance and risk management processes in place; including health and safety and the management of medical emergencies.

• The practice had a comprehensive system to monitor and continually improve the quality of the service through a detailed programme of clinical and non-clinical audits. However the practice manager told us they had not been given access by the provider to take action to mitigate the identified areas of risk in relation to equipment and environmental improvements.

• The practice had an accessible and visible leadership team with clear means of sharing information with staff.

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 in a timely way.

• Ensure the training, learning and development needs of staff members are reviewed at appropriate intervals and an effective process is established for the on-going assessment and supervision of all staff employed.

We visited Peasedown Dental Practice in May 2013 and raised concerns about the safety and suitability of the premises. We also had concerns around some of the fixtures, fittings and equipment where they related to the Department of Health guidance for the safe decontamination of dental instruments and the prevention and control of infections. We went back in October 2013 and found the concerns around the premises had been addressed. Some of the concerns around infection prevention and control had been addressed, but other improvements were either not made or were not satisfactory. The practice said it would readdress these concerns and acceptable improvements would be completed by 20 December 2013.

We went back to the practice on 8 January 2014 to check if the actions taken were now satisfactory. We found new flooring had been laid in both dental treatment rooms to a good standard. Other areas where the edges of cabinets were damaged had been repaired. The clinical waste bins were now foot operated and had been fitted to ensure no other items could be stored behind the clinical waste disposal bins. The other concerns we raised had been addressed. This included arrangements for the provider to respond effectively to requests for equipment to be maintained or replaced when qualified and/or experienced staff made those requests.

We visited Peasedown Dental Practice in May 2013 and found improvements were needed to infection prevention and control facilities and procedures, and the safety of the premises. We found The Department of Health decontamination requirements were not followed in relation to fixtures, fittings and equipment in the practice. The facilities for staff and visitors were cramped and did not provide space for staff to work efficiently. Some fixtures, fittings and equipment were not adequately maintained.

The provider sent us an action plan which outlined what it would do to improve infection prevention and control, and the safety of the premises. The action plan covered all our areas of concern and we were told improvements would be made within an acceptable time frame. We went back to the practice in October 2013 to check on these improvements having been told they would be completed.

We found most of the areas around the safety of the premises had been dealt with. There were some issues the provider had not found a solution for, including the cramped nature of the premises and planning effectively for the future.

We found most of the infection prevention and control improvements described by the practice had been made to a reasonable standard. However, some areas required by Department of Health technical guidance had not been adequately addressed.

There was no action plan for working towards implementing standards to meet best practice in decontamination. The treatment room flooring had been repaired, but the repairs were not effective. The flooring remained in poor condition in one of the rooms. The metallic bases of the dental chairs in treatment room one remained in poor condition. The clinical waste cabinets still needed to be opened by hand, and there were excess items of stock held within the clinical waste cupboards. Some of the framework of the cabinets in treatment room one was damaged and the covering was peeling away from the surface.

People we met at Peasedown Dental Practice were happy with their care and treatment. They said they could get appointments to suit them, including for urgent treatment. There were arrangements for people to get help when the practice was closed.

The dentists talked with people about their general health and made sure the practice had all the relevant information before treating someone. Dental staff knew how to act in the event of a medical emergency and had appropriate emergency equipment. The dentists took time to explain to people the risks and benefits of any treatment. People made up their own mind about how to progress with proposed treatment and could withdraw consent at any time.

The practice manager had a system in place for regularly monitoring the quality and safety of the service provided. This included the views of staff, although the process for capturing the views of people who used the service could be more effective.

The practice and equipment was generally clean. However, requirements for the prevention and control of infection for dental practices in relation to fixtures, fittings and equipment for decontamination were not followed. The premises were small and although tidy and well organised, storage space and facilities for staff were limited. Some of the fixtures, fittings and services in the premises were old and in need of updating or effective maintenance.