We carried out a follow up inspection on 19 October 2016 of North Street Dental Care. We had undertaken an announced comprehensive inspection of this service on 31 March 2016 as part of our regulatory functions and during this inspection we found a breach of the legal requirements.

After the comprehensive inspection, the practice wrote to us to say what they would do to meet the legal requirements in relation to the breach. This report only covers our findings in relation to those requirements. We checked whether they had followed their action plan to confirm that they now met the legal requirements.

We reviewed the practice against one of the five questions we ask about services: is the service safe?

We have not revisited North Street Dental Care as part of this review because the practice was able to demonstrate that they were meeting the standards without the need for a visit.

A copy of the report from our last comprehensive inspection can be found by selecting the 'all reports' link for North Street Dental Care on our website at www.cqc.org.uk.

Our findings were:

Are services

safe

?

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

Background

North Street Dental Care provides predominately NHS dental services with private treatment options for patients. The practice has three consulting and treatment rooms, has three dentists who are supported by four dental nurses. The practice is managed by a practice manager with a principal dentist supporting the whole team.

Surgery hours are Monday to Friday, 9am to 5pm. There are arrangements in place to ensure patients receive urgent medical assistance when the practice is closed.

Our key findings were:

• The practice had reviewed their infection prevention and control procedures and protocols 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’.
• Training on adult and paediatric basic life support and the use of a automated external defibrillator (AED) had been undertaken by all members of staff.
• Systems had been implemented to ensure that single use items were disposed of in line with the manufacturer’s instructions and only used on one patient.
• We were assured that the practice no longer used an unregistered laboratory for any dental prosthesis.
• References for all members of staff had been obtained following our comprehensive inspection.

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

• Ensure that all staff undertake a serum conversion to determine their level of immunity to Hepatitis B.
• Revisit their infection control audit to reflect the fact that a washer disinfector is not used in the practice.

We carried out an unannounced comprehensive inspection on 31 March 2016 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 not 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 providing well-led care in accordance with the relevant regulations

Background

North Street Dental Care provides predominately NHS dental services with private treatment options for patients. The practice has three consulting and treatment rooms, has three dentists who are supported by four dental nurses. The practice is managed by a practice manager with a principal dentist supporting the whole team.

One of the dentists 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.

We spoke with four patients who told us that they were satisfied with the services they had received. All stated their experiences at the practice were good, that staff were kind and caring and appointments were readily available both for emergencies and routine visits. They spoke about how their dignity and privacy was maintained at all times and how they were involved in decisions regarding their care and treatment. We did not receive any comment cards prior to our inspection as this was unannounced.

Our key findings were:

• Staff had reported incidents and kept records of these and used the information for shared learning.
• Infecton control arrangements were not sufficient
• Single use items were used more than once on patients.
• Patients’ needs were assessed and care was planned and delivered in line with current best practice guidance from the National Institute for Health and Care Excellence (NICE) and other published guidance.
• The practice had effective safeguarding processes and staff understood their responsibilities for safeguarding adults and children living in vulnerable circumstances.
• Staff had received some training appropriate to their roles and were supported in their continued professional development (CPD).
• Where risk assessments had been carried out the practice had not implemented the actions required to minimise the risks identified.
• The provider and dentists used an unregistered laboratory for crowns, bridges, inlays, veneers and dentures.
• The practice took into account any comments, concerns or complaints and used these to help them improve the practice.
• Patients were pleased with the care and treatment they received and complimentary about the dentists and all other members of the practice team.

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

• Ensure infection prevention and control policies and procedures are implemented that follow the

Department of Health’s Code of practice about infection prevention and control of healthcare

associated infections (Health and Social care Act 2008: Code of practice for health and adult social care on the prevention and control of infections and related guidance) and the Department of Health – Health Technical Memorandum 01-05: Decontamination in primary care dental practices (HTM 01-05)

• Ensure that appropriate governance arrangements are implemented for the safe running of the service by establishing systems to identify and minimise any potential or perceived risks.
• Ensure that single use items are disposed of in line with the manufactures instructions and only used on one patient.
• Ensure that training in basic life support and use of the AED is carried out annually
• Ensure that only registered laboratories are used for any dental prosthesis.

When we visited we spoke with four patients. They told us that they were well informed about their treatment and the options open to them, including any costs involved. People we spoke with told us that any discussions regarding treatment took place in the privacy of the surgery. We observed staff interaction with patients both in person and on the phone and found that staff were always patient, respectful and informative.

We examined three recent patient records and saw that all pre-treatment checks including soft tissue, medical history and lifestyle were carried out, treatment options had been explained and consent forms signed. One patient said, "The staff are all lovely and my dentist always tells my exactly what he is going to do."

We saw that the reception and waiting areas were comfortable and presented a high level of overall cleanliness. Surgeries were hi-tech, spacious and clinically hygienic to a high standard with robust systems in place for equipment and instrument cleaning. Staff were well informed about hygiene and infection control policies and able to demonstrate effective decontamination procedures in detail to us.

We spoke with three members of staff and looked at the practice policy in relation to safeguarding, complaints and whistleblowing. Staff were well informed regarding procedures to protect vulnerable people if they felt they were at risk and the practice had comprehensive policies in place.