We carried out a focused inspection of Phoenix Dental – Bradley Stoke on 15 November 2017.

The inspection was led by a CQC inspector who had access to telephone support from a dental clinical adviser.

We carried out the inspection to follow up concerns we originally identified during a comprehensive inspection at this practice on 18 July 2017 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions.

At a comprehensive inspection we always ask the following five questions to get to the heart of patients’ experiences of care and treatment:

• Is it safe?
• Is it effective?
• Is it caring?
• Is it responsive to people’s needs?
• Is it well-led?

When one or more of the five questions is not met we require the service to make improvements and send us an action plan. We then inspect again after a reasonable interval, focusing on the area(s) where improvement was required.

At the previous comprehensive inspection we found the registered provider was providing safe, effective, caring and responsive care in accordance with relevant regulations. We judged the practice was not providing well-led care in accordance with Regulation 16 Receiving and acting on complaints and Regulation 19 Fit and proper persons employed of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can read our report of that inspection by selecting the 'all reports' link for Phoenix Dental – Bradley Stoke on our website www.cqc.org.uk.

We also reviewed the some of the key questions of safe and effective as we had made recommendations for the provider relating to these key questions. We noted that improvements had been made.

Our findings were:

Are services well-led?

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

The provider had made improvements to put right the shortfalls and dealt with the regulatory breaches we found at our inspection on 18 July 2017.

We carried out this announced inspection on 18 July 2017 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.

We told the NHS England area team and Healthwatch that we were inspecting the practice. They did not provide any information.

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

Phoenix Dental – Bradley Stoke is in Bradley Stoke in South Gloucestershire and provides mainly NHS with some additional private treatment to patients of all ages.

The practice is within a shopping complex and is on the first floor. There is a lift available for patients who use wheelchairs and pushchairs. The shopping complex has a large car park with the ability to park for four and half hours at a time. There are also a number of allocated disabled and family car parking spaces.

The dental team includes four dentists, four dental nurses and two trainee dental nurses, one dental hygienist and four receptionists. The practice has three treatment rooms.

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 Phoenix Dental – Bradley Stoke was the practice manager.

On the day of inspection we collected ten CQC comment cards filled in by patients and spoke with two other patients. This information gave us a positive view of the practice.

During the inspection we spoke with two dentists, three dental nurses, two receptionists, the practice manager and the compliance 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 8:30am until 5:45pm

• Thursdays from 8:30am until 7pm

• Saturdays from 9am until 1pm

Our key findings were:

• The practice appeared clean and well maintained.
• The practice had infection control procedures which reflected published guidance.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• The practice had systems to help them manage risk.
• The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• The provider had thorough staff recruitment procedures. However, these had not been followed including ensuring current legislation was in place.
• 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.
• The appointment system met patients’ needs.
• The practice asked staff and patients for feedback about the services they provided.
• The practice dealt with complaints positively. Although complaints were not always dealt with within company timescales.

We identified regulations the provider was not meeting. They must:

• Ensure the practice's recruitment policy and procedures are followed and the recruitment arrangements are in line with Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 to ensure necessary employment checks are in place for all staff and the required specified information in respect of persons employed by the practice is held.
• Ensure that a system for identifying, receiving, recording, handling and responding to complaints by patients is established.

Full details of the regulations the provider was not meeting are at the end of this report.

There were areas where the provider could make improvements. They should:

• Review the practice’s system for the recording, investigating and reviewing incidents or significant events with a view to preventing further occurrences and, ensuring that improvements are made as a result
• Review practice policy on how urgent referrals should be monitored and followed up to establish the patient has received the treatment required.
• Review its responsibilities as regards to the Control of Substance Hazardous to Health (COSHH) Regulations 2002 and, ensure all documentation is up to date and staff understand how to minimise risks associated with the use of and handling of these substances.

During our visit we spoke with six people who were attending the practice for checks or treatment. They referred to the “relaxed experience”, “friendly and helpful staff” and being “happy with the treatment they received”. Parents told us the dentists were “good with children”.

People spoke about the cleanliness of the practice and one person told us how reassuring they found it that they observed staff washing their hands, putting on fresh protective clothing and saw a needle being removed from it’s packaging prior to receiving anaesthesia.

One person described the dentist they saw as “absolutely fabulous” and another person told us how the dentist they saw persuaded them to have an extraction at the practice rather than being referred to another provider for treatment under general anaesthetic. They said the extraction was “painless”.

People received treatment through the NHS and privately if they wished. Every care was taken to ensure that the treatment they received was appropriate and staff were trained to ensure it was delivered safely.

There were arrangements in place to protect people and respond to any suspicions of abuse.

Staff told us they felt supported and there were systems and training opportunities in place to ensure their continuing development.

The provider had an effective system to measure the quality of service and ensure that improvements were made where necessary.

People who use the service told us that their treatment is well explained and they are aware of all the costs involved. We were told that it was easy to book appointments.