My Dentist - Padiham Road, Burnley is in the village of Padiham and provides NHS and private treatment to adults and children.

There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces, including two for blue badge holders, are available near the practice side entrance.

The dental team includes 10 dentists,12 dental nurses, three trainee dental nurses, two dental hygienists, one dental hygiene therapist, one treatment co-ordinator and three receptionists. The practice also has three visiting implantologists, one visiting orthodontist and one orthodontist who is seeing a small number of patients they treated whilst working at the practice. The practice is managed on a day to day basis by a practice manager. The practice has 12 treatment rooms; six on the ground floor and six on the first floor.

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 My Dentist Padiham Road, Burnley is the practice manager.

The practice is open Monday, Tuesday, Wednesday and Friday from 8am to 5.30pm. On Thursday the practice is open from 8am to 7pm. The practice is open on some Saturday mornings to accommodate certain advance patient bookings only.

To conduct our follow-up inspection we spoke with the practice manager, who provided evidence of action taken to address identified regulatory breaches.

Our key findings were:

Systems or processes had been established and appeared to be operating effectively to ensure compliance with the requirements of the fundamental standards as set out in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. In particular:

• Work scheduled to be carried out at the practice in the week following our visit, to address longstanding issues with management of Legionella had been completed.
• A new Legionella risk assessment had been carried out to assure that work completed on the water supply system, had addressed issues raised by our inspection.

• A key security log had been introduced to ensure that only authorised persons had access to keys, for example, to access medicines used in sedation.

• All required checks for permanently employed staff were in place. Procedures for assurance of recruitment checks on locum staff had been improved.
• A new practice manager was in place at the practice. The practice manager confirmed support was provided to ensure understanding of regulatory standards required within a dental setting.
• The practice manager held records of professional development for all staff, which only they could update. The introduction of this system meant staff had to show evidence of training completed, so that the practice log could be updated.

We saw evidence of further improvements made by the provider. We found:

• Further training had been delivered to all staff on the practice whistleblowing policy. All staff had signed a practice meeting log to confirm this training had been received. Any staff identified as being absent were given the opportunity to complete this training.

• A maintenance issues log was kept by the practice, to enable follow-up of any works outstanding. A review had also been held by the corporate level health and safety team, and systems introduced to ensure that works required at practice level were not unduly delayed.

We carried out this announced inspection on 3 January 2019 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 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 not providing well-led care in accordance with the relevant regulations.

Background

My Dentist - Padiham Road, Burnley is in the village of Padiham and provides NHS and private treatment to adults and children.

There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces, including two for blue badge holders, are available near the practice side entrance.

The dental team includes 10 dentists, 12 dental nurses, three trainee dental nurses, two dental hygienists, one dental hygiene therapist, one treatment co-ordinator and three receptionists. The practice also has three visiting implantologists, one visiting orthodontist and one orthodontist who is seeing a small number of patients they treated whilst working at the practice. The practice is managed on a day to day basis by a practice manager. The practice has 12 treatment rooms; six on the ground floor and six on the first floor.

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 My Dentist Padiham Road, Burnley is the practice manager.

On the day of inspection, we collected three CQC comment cards filled in by patients. All patient feedback given was positive.

During the inspection we spoke with five dentists, two dental nurses, the area compliance manager 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, Tuesday, Wednesday and Friday from 8am to 5.30pm. On Thursday the practice is open from 8am to 7pm. The practice is open on some Saturday mornings to accommodate certain advance patient bookings only.

Our key findings were:

• The practice appeared clean and well maintained.
• The provider had infection control procedures which reflected published guidance.
• We saw that work was scheduled to be carried out at the practice in the week following our visit, to address longstanding issues with management of Legionella. This had been unduly delayed.
• On the day of inspection, keys to a cabinet where medicines used for sedation where kept, were not available. This was due to a staff member taking them off site. As a result of this we were unable to inspect medicines held in the cabinet to check they corresponded with records held for the secure keeping of medicines used for sedation.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• The practice had systems to help them manage risk to patients and staff. Our inspection showed that these systems were not always followed.
• The provider had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
• The provider had staff recruitment procedures in place for permanent staff. These were not always followed. All required checks for permanently employed staff were not in place. Procedures for assuring checks on locum staff required improvement.
• 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.
• Staff were providing preventive care and supporting patients to ensure better oral health.
• The appointment system took account of patients’ needs.
• Leadership at practice level was sufficient; we found support for the practice leadership could be improved.
• Staff felt involved and supported and worked well as a team at practice level.
• The provider asked staff and patients for feedback about the services they provided.
• The provider dealt with complaints positively and efficiently.
• The provider had suitable information governance arrangements.

We identified regulations the provider was not complying with. They must:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

Full details of the regulation the provider is not meeting is at the end of this report.

We carried out an announced comprehensive inspection on 16 November 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 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

Mydentist Padiham Road Burnley is part of the Integrated Dental Holding Ltd (IDH) Dental Group the largest dental care provider in Europe. The practice is situated in a converted three storey residential property in Padiham, Burnley. There are 12 treatment rooms in total six on the ground floor and six on the first floor. On the day of the inspection there were five dentists working in the practice, they were supported by 10 dental nurses, three receptionists and the practice manager.

The practice was open Monday, Tuesday, Wednesday and Friday from 8.30am until 5.30pm and Thursday 8am until 7pm.

The practice manager 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 37 completed CQC comments cards from patients who had visited the practice in the two weeks before our inspection. In addition we spoke with three patients on the day of the inspection.

Our key findings were:

• Staff had received safeguarding and whistleblowing training and knew the processes to follow to raise any concerns.
• The provider had emergency medicines available in line with the British National Formulary (BNF) guidance for medical emergencies in dental practice.
• Audits were carried out on radiography and dental care records at regular intervals to help improve the quality of service
• Patients received clear explanations about their proposed treatment, costs, benefits and risks and were involved in making decisions about treatment.
• The appointment system met the needs of patients and waiting times were kept to a minimum.
• The practice was well-led and staff felt involved and worked as a team.
• The practice sought feedback from staff and patients about the services they provided.
• There was an effective complaints system. The practice manager recorded complaints and cascaded learning to staff.
• The patients we spoke with and the comment cards we reviewed indicated patients were treated with kindness and respect by staff.
• Staff felt well supported by the practice manager and were committed to providing a quality service to their patients.

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

• Check all audits have learning point’s action plan and dates for completion documented so that improvements can be demonstrated.
• Ensure all staff are aware of their role and responsibilities of the requirements of the Mental Capacity Act (MCA) 2005. Review staff awareness of the Gillick competencies.
• Review the practice's recruitment procedures to ensure references for new staff are requested and recorded suitably.
• Check all dental products in the second floor store cupboard to ensure they are within the expiry date and fit for use.
• Ensure the most up to date policies and procedures are easily available for staff to reference.
• Ensure keyboards in treatment rooms are covered or easy clean.

We spoke with three people that used the service. They told us, “This is the best dentist we have been to; they are very gentle and never hurt us. We have no complaints at all” also “I am told the cost of the treatment and we are very happy with the dentist they are very good and very polite”.

One patient told us they sometimes had difficulties accessing appointments before or after school times and had to wait a while to receive treatment.

We looked at five patient records, these told us that patients treatment had been discussed with them and where necessary copies of their treatment plans provided. These also informed the patient of the cost of their treatment.

The practice had effective systems in place to ensure patients were cared for in a clean and hygienic environment.

During our visit we saw a range of patient information leaflets available in the waiting room. We observed staff treating people in a kind, professional, friendly and respectful manner.

All consultations took place in private rooms and were situated on the ground and first floor of the building.