We carried out an announced comprehensive inspection of this practice on 4 November 2015. Breaches of legal requirements were found. After the comprehensive inspection, the practice wrote to us to say what they would do to meet legal requirements in relation to braches in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Part 3) Regulation 12: Safe care and treatment; and Regulation 17: Good governance. We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Lyndhurst Family Dental Centre on our website at www.cqc.org.uk

We carried out an announced follow up inspection on 17 November 2016 to ask the practice the following key questions; Are services well-led?

Our findings were:

Are services well-led?

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

Background

Lyndhurst Family Dental Centre is situated over three floors of premises in Nottingham. The patient areas occupy the ground and first floor. The practice is accessible to patients with restricted mobility, such as those in a wheelchair. The practice provides regulated dental services to patients in Nottingham and the surrounding area. The practice provides mostly NHS dental treatment. Services provided include general dentistry, dental hygiene, and root canal treatments.

The practice was open: Monday to Thursday: 8:30 am to 5:30 pm and Friday: 8:30 to 5 pm.

Access for urgent treatment outside of opening hours was by ringing the practice telephone number and following the answerphone message. Alternatively patients could telephone the NHS 111 telephone number.

The practice has five dentists, one therapist, nine qualified dental nurses and one trainee dental nurse.

Our key findings were:

• The practice had been totally refurbished since the inspection of the 4 November 2015. The refurbishment had seen new flooring, in clinical areas, new cabinets and work surfaces, new seating in the waiting areas and new ceiling tiles together with a complete redecoration in the provider’s corporate colour and design scheme.
• Clinical waste bags were clearly marked with the practice name and address.
• X-rays taken at the practice were graded and justified for quality purposes in the patients’ dental care records.
• Chemicals used at the practice during the X-ray process were stored safely and appropriately.

Arrangements had been made to introduce digital X-rays at the practice during December 2016. As a result the chemicals used in the X-ray development process would be dispensed with.

We carried out an announced comprehensive inspection on 21 October 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

We carried out a comprehensive inspection of Lyndhurst Family Dental Practice on 4 November 2015. The practice is a member of mydentist group and provides both NHS and private dental treatment to patients of all ages. The practice has six self-employed dentists, one dental therapist, and employs nine dental nurses, one trainee dental nurse, and a practice manager.

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 practice operates over 2 floors in a four storey building converted from two houses. Access to the main reception area, one consultation room and patient toilet (suitable for disabled people) is on ground level, with three treatments rooms and waiting area accessible by a few steps. Additional surgeries, waiting area and patient toilet, not accessible to patients who cannot negotiate stairs, are located on the upper first floor and second floor. There is on street parking available around the building.

The practice is open Monday to Friday from 9.00am to 5.30pm, late opening for both NHS and private patients is offered, the times vary and displayed in the waiting areas. Domiciliary dentistry is offered to patients living in local care homes.

We spoke with four patients during our inspection and received four comments cards that had been completed by patients prior to our inspection. We received positive comments about the cleanliness of the premises, the empathy, and responsiveness of staff and the quality of treatment provided. Patients commented that the building is in need of refurbishment.

The patients we spoke with told us that staff explained treatment to them well and reported that the practice had seen them on the same day for emergency treatment. Patients commented that the service they received was good, and that they were always clear about the costs involved in their treatment.

Our key findings were:

• Poor maintenance of the building fabric, fixtures, and fittings had potentially compromised the practice’s ability to comply with infection prevention standards.

• The practice had systems to help ensure patient safety. These included safeguarding children and adults from abuse, and assessing risks to staff and patients.

• Staff received training appropriate to their roles and supported in their continued professional development.

• There were sufficient numbers of staff to meet patients’ needs.

• Patients’ needs were assessed and care was planned in line with guidance from the National Institute for Health and Care Excellence (NICE).

• The practice sought feedback from staff and patients and used it to improve the service provided.

• There was a lack of clinical leadership and systems evident in the practice to ensure quality assurance of standards and processes.

• The assurance process for monitoring the quality of X-ray images was irregular and insufficient to reduce the risk of patients being subjected to further unnecessary X-rays.

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

• Ensure that the fabric of the building, fixtures, and fittings are maintained to comply with infection prevention standards.
• Strengthen quality assurances processes to ensure that standards are met to keep patients and staff safe.
• Ensure that all clinical waste is labelled and collected regularly.
• Ensure that regular quality checks of X-ray images are undertaken, recorded, where quality is poor, it is investigated, and changes made to ensure that patients are kept safe.
• Ensure accurate record keeping for changing of chemicals used in the X-ray developing machine.

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

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

• Improve the system to ensure that learning from individuals, their audits, and reviews is recorded, shared, and available with the wider practice team.
• Strengthen the clinical leadership within the practice.

People who used the service understood the care and treatment choices available to them. We spoke with five people using the service. They all told us that they were treated with dignity and respect by all of the staff employed at the service. People said clear explanations of the various treatment options and costs were explained to them by the dentist. One person told us: “All the staff are very nice, they explain things well and are friendly and polite. Another person told us that they were able to arrange an appointment for the same day when they had toothache.

All patients that we spoke with told us that they were satisfied with the standard of care and treatment provided. They told us that they felt safe using this service and that it was clean and hygienic.