We undertook a follow up focused inspection of Newcastle Denture Services Ltd on 8 April 2019. This inspection was carried out to review in detail the actions taken by the registered provider to improve the quality of care and to confirm that the practice was now meeting legal requirements.

The inspection was led by a CQC inspector who was had remote access to a specialist dental adviser.

We undertook a comprehensive inspection of Newcastle Denture Services Ltd on 23 January 2019 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We found the registered provider was not providing well led care and was in breach of regulation 17 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 Newcastle Denture Services Ltd on our website www.cqc.org.uk.

As part of this inspection we asked:

• Is it well-led?

When one or more of the five questions are 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 where improvement was required.

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 in relation to the regulatory breach we found at our inspection on 23 January 2019.

Background

Newcastle Denture Services Ltd is in Newcastle-under-Lyme in Staffordshire and provides private treatment mostly to adults.

There is level access for people who use wheelchairs and those with pushchairs. There is car parking available at the practice including spaces for blue badge holders.

The dental team includes one Clinical Dental Technician, three part-time dentists, one dental hygiene therapist, one qualified dental nurse, one receptionist, three laboratory technicians and the practice manager. The practice has two treatment rooms, both of which are on the ground 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 Newcastle Denture Services Ltd is the practice owner and Clinical Dental Technician.

During the inspection we spoke with the practice owner. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open: Monday to Friday: from 8.30am to 5.30pm.

Our key findings were:

• The first aid box had been replaced and a system introduced to check the contents on a weekly basis to ensure they were in date and ready for use.
• The emergency equipment had been reviewed and the system for regular checks of the equipment had been updated.
• Relevant staff had received training in appraisals, and all staff had received an appraisal of their performance during March 2019.
• The system for completing audits had been reviewed, and records showed audits had been completed throughout March 2019.
• The risk assessments in the Control of Substances Hazardous to Health folder had been reviewed and information updated and indexed.

We carried out this announced inspection on 23 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

Newcastle Denture Services Ltd is in Newcastle-under-Lyme in Staffordshire and provides private treatment mostly to adults.

There is level access for people who use wheelchairs and those with pushchairs. There is car parking available at the practice including spaces for blue badge holders.

The dental team includes one Clinical Dental Technician, three part-time dentists, one dental therapist, one qualified dental nurse, one receptionist, three laboratory technicians and the practice manager. The practice has two treatment rooms, both of which are on the ground 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 Newcastle Denture Services Ltd is the practice owner and Clinical Dental Technician.

On the day of inspection, we collected 22 CQC comment cards filled in by patients and spoke with two other patients.

During the inspection we spoke with the practice owner, one dentist, two dental nurses, one clinical dental technician and two receptionists. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open: Monday to Friday: from 8.30am to 5.30pm.

Our key findings were:

• The practice appeared clean and well maintained.
• The provider had infection control procedures which reflected published guidance.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• Systems for checking that medical emergency equipment was in date were ineffective.
• The practice had systems to help them manage risk to patients and staff.
• The information relating to the Control of Substances Hazardous to Health required review.
• The provider had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
• The provider had the staff recruitment information required by the regulations.
• 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.
• The provider’s systems and processes for leadership and continuous improvement were not always effective.
• Staff felt involved and supported and worked well as a team.
• The staff annual appraisals were overdue.
• 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.
• Audits at the practice did not always have action plans or learning points to demonstrate that improvements had been achieved.

We identified a regulation 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.