Further to the outcome of a previous inspection, carried out in November 2015, we carried out an announced focused inspection relating to the safe and well led provision of services on 2 August 2016 to ask the practice the following key questions;

Are services safe in relation to staff recruitment and infection control?

Our findings were:

Are services safe?

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

Background

CQC inspected the practice on 20 November 2015 and asked the provider to make improvements regarding:

• Regulation 12 HSCA (RA) 2014 Safe Care and Treatment

• Regulation 19 HSCA (RA) Regulations 2014 Fit and Proper Persons employed

We checked these areas as part of this focused inspection and found these had been resolved.

Riverside Dental Practice is a dental practice providing mainly NHS and some private treatment and caters for both adults and children. The practice is situated in a converted commercial property above a veterinary practice. The practice has three dental treatment rooms with a decontamination area for cleaning, sterilising and packing dental instruments within each treatment room and a reception and waiting area.

The practice employs four dentists, a dental hygienist and four dental nurses, three of whom are in training and on a recognised training course. Supporting the clinical staff is a practice manager and four reception staff. The practice’s opening hours are 8am to 8pm Monday to Friday. The practice operates a shift system with half of the staff working from 8am until 2pm and the remaining staff working from 2pm until 8pm.

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.

The inspection was carried out by a CQC inspector.

Our key findings were:

• Infection control procedures were robust and the practice followed published guidance.

• Staff recruitment files contained essential information in relation to Regulation 19, Schedule 3 of Health & Social Care Act 2008 (Regulated Activities) Regulations 2015.

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

• Amend the practice's recruitment policy so that procedures are in line with Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, specifically by undertaking health assessment checks in respect of persons prior to employment at the practice.

• Review recording processes for the validation of instrument decontamination equipment.

During and after our visit we spoke with three patients about their care and treatment. Everybody told us that the dentist spent time discussing their treatment plan. One patient said: “I am very happy with the treatment I receive”. Everybody we spoke with was very complimentary about the care they received. One patient commented in a recent survey: ‘I always receive excellent care and attention’.

We also looked at patient records which enabled us to see the information recorded for each person's visit. The dentist had recorded their examination of soft tissues, teeth and other relevant observations.

We saw there were systems in place to reduce the risk and spread of infection. During our visit we spoke to clinical staff at the practice. They were aware of the safe practices required to meet the essential standards of Department of Health guidance.

We carried out an announced comprehensive inspection on 23 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 not providing well-led care in accordance with the relevant regulations?

Background

Riverside Dental Practice is a dental practice providing mainly NHS and some private treatment and caters for both adults and children. The practice is situated in a converted commercial property above a veterinary practice. The practice has three dental treatment rooms with a decontamination area for cleaning, sterilising and packing dental instruments within each treatment room and a reception and waiting area.

The practice employs four dentists, a dental hygienist and four dental nurses all of whom are in training and on a recognised training course. Supporting the clinical staff is a practice manager and five reception staff. The practice’s opening hours are 8am to 8pm Monday to Friday. The practice operates a shift system with half of the staff working from 8am until 2pm and the remaining staff working from 2pm until 8pm.

There was no registered manager at the time of our inspection at this location. We were told that the current Practice Manager was going through the CQC registration process 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.

Before the inspection we sent Care Quality Commission comment cards to the practice for patients to complete to tell us about their experience of the practice. We collected 17 completed cards and asked 41 patients for their opinion of Riverside Dental Practice. These provided a mainly positive view of the services the practice provides. However three comments were less favourable and included dentists not starting their morning appointment on time and being behind schedule and staff not being supported.

We carried out an announced comprehensive inspection on 23 November 2015 as part of our planned inspection of all dental practices. The inspection was carried out by a lead inspector and a dental specialist adviser.

Our key findings were:

• Staff had been trained to handle emergencies and appropriate medicines and life-saving equipment was readily available in accordance with current guidelines.
• The practice manager acted as safeguarding lead with effective safeguarding processes in place for safeguarding adults and children living in vulnerable circumstances.
• Staff reported incidents and kept records of these which the practice used for shared learning.
• Information from 17 completed Care Quality Commission comment cards gave us a mainly positive picture of a friendly, professional service.
• All complaints were dealt with in an open and transparent way by the practice manager if a mistake had been made.
• The practice had a programme of clinical and non-clinical audit in place.
• Infection control procedures followed published guidance although the cramped space in each treatment room and the clutter in treatment rooms did not facilitate ease of process.
• Staff reported that there was not enough staff to deliver the service.
• There had been a succession of practice managers over the previous 12 months which had contributed to staff feeling that there was inadequate overall leadership at the practice. The practice manager was new and being supported by a support manager and together they were addressing shortfalls in the practice.
• The practice was poorly maintained with obvious structural deficiencies including a rotten window frame and holes and defects in the wall of treatment room two. The practice was cluttered and the carpet running through the central corridor of the practice appeared unclean. The sinks used for decontamination in treatment room one was poorly fixed to the dental cabinetry. We were shown the order of works which would remedy this situation.
• Staff were committed to providing a quality service to their patients but the staff we spoke with told us they felt inadequately supported by the corporate provider.
• The shift pattern operated by the practice did not allow staff sufficient time to adequately prepare for the start of each new shift. The high treatment targets that had been set for this location may have contributed to this finding.
• The acceptance policy of the practice with respect to new patients, and the delays between registering and seeing these patients was reported to be generally over three months.

We identified regulations that were not being met and the provider must:

• Establish an effective system to assess, monitor and mitigate the risks relating to the health, safety and welfare of patients, staff and visitors.
• Ensure recruitment arrangements include all necessary employment checks for all staff.

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

• Provide staff with sufficient time to adequately handover to new staff at the start of each shift.
• Undertake a full oral health examination of new patients in a timely way.

You can see full details of the regulations not being met at the end of this report.