We carried out a focused inspection of Newport Dental Practice on Monday 16 October 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 28 June 2016 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 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 Newport Dental Practice on our website www.cqc.org.uk.

We also reviewed 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 deal with the regulatory breach we found at our inspection on 28 June 2016.

Newport Dental Practice has two dentists who work full time, one of whom is the principal dentist, and one part time dentist. There are two qualified dental nurses who are registered with the General Dental Council (GDC) and two trainee dental nurses. In addition to these staff there is also a part time practice manager, two part time hygienists and two receptionists. The practice’s opening hours are 9am to 5.30pm on Monday to Thursday and 9am to 5pm on Friday. The practice closes for lunch for one hour each day.

Newport dental practice provides NHS dental treatment for adults and children. The practice has seven dental treatment rooms, one of which is on the ground floor and two of which are currently not in use. There is also a separate decontamination room for cleaning, sterilising and packing dental instruments. There is also a reception with adjoining waiting area.

The principal dentist is registered with the Care Quality Commission (CQC) as an individual. 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 comments cards to the practice for patients to complete to tell us about their experience of the practice and during the inspection we spoke with patients. We received feedback from 13 patients who provided a positive view of the services the practice provides. All of the patients commented that the quality of care was good.

Our key findings were

• Systems were in place for the recording and learning from significant events and accidents.
• There were sufficient numbers of suitably qualified staff to meet the needs of patients.
• Patients were treated with dignity and respect.
• The practice was visibly clean and well maintained.
• Infection control procedures were in place with infection prevention and control audits being undertaken on a six monthly basis. Staff had access to personal protective equipment such as gloves and aprons.
• The provider had emergency medicines in line with the British National Formulary (BNF) guidance for medical emergencies in dental practice.
• Staff had been trained to deal with medical emergencies although annual update training was required for two staff.
• The appointment system met the needs of patients and waiting times were kept to a minimum.
• Patients received clear explanations about their proposed treatment, costs, benefits and risks and were involved in making decisions.
• Staff demonstrated knowledge of whistleblowing and were confident they would raise a concern about another staff member’s performance if it was necessary.
• Staff felt involved at the practice and said that everyone worked as a team.

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

• Ensure an effective system is established to assess, monitor and mitigate the various risks arising from undertaking of the regulated activities. This should include the appropriate siting of sharps bins; ensuring appropriate signage is on doors where oxygen is stored and ensuring that staff are up to date with the IRMER training.
• Review the storage of dental care records to ensure it is secure and in accordance with the Data Protection Act 1998.
• Ensure an affective system is established to assess, monitor and improve the quality and safety of the services provided. This should include a review of the practice’s systems in place to seek and act on feedback from patients. Review the practice’s audit protocols of various aspects of the service, such as and radiography at regular intervals to help improve the quality of service. The practice should also check that all audits have documented learning points and any resulting improvements can be demonstrated.

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:

• Review the storage of products identified under Control of Substances Hazardous to Health (COSHH) 2002 Regulations to ensure they are stored securely.
• Review the security of prescription pads in the practice.
• Review the practice’s infection control procedures giving due regard to guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices and The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance. Give further consideration to the layout of the decontamination room to reduce the risk of cross contamination.
• Review the practice’s waste handling procedures to ensure waste is segregated and stored in accordance with relevant regulations giving due regard to guidance issued in the Health Technical Memorandum 07-01 (HTM 07-01).
• Review the availability of information leaflets at the practice regarding treatments and promotion of oral hygiene to ensure that patients have sufficient information available to them

We spoke with seven people who attended the dental practice. They told us that they were very satisfied with the service and treatment that they received.

Everyone we spoke with confirmed that they had been involved in making decisions about their dental care and treatment options. They said they were given clear information about their treatment. People told us that dental staff always explained procedures to them. One person told us, “Everything is explained very well. They are all very professional”.

People told us that their privacy and dignity was maintained and that they felt safe and relaxed in the surgery. We saw that staff were friendly and welcoming.

Staff told us they were well supported in their work. They told us they had regular training opportunities and effective support from the practice owner and the manager.

We saw arrangements in place to deal with emergency situations. Staff had received training to manage medical emergencies.

We saw that the practice had procedures in place for the management of infection control. Staff had received training to reduce the risk of infection. People told us they were confident that good standards of cleanliness were maintained.

We saw the complaints procedure. People we spoke with were not aware of the formal complaints process but said that they would be confident to speak with staff if they had a worry or concern. Information was available should people want to make a complaint.