Further to the outcome of a previous inspection, carried out in March 2016, we carried out an announced focused inspection relating to the well led provision of services on 12 September 2016 to ask the practice the following key questions;

Are services well-led in relation to governance; specifically staff recruitment and training?

Our findings were:

Are services well-led?

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

Background

CQC inspected the practice on 12 September 2016 and asked the provider to make improvements regarding:

• Regulation 18 Regulations 2014 Staffing
• Regulation 19 Regulations 2014 Fit and Proper Persons employed

We checked this area as part of this focused inspection and found this had been resolved.

North Street Dental & Aesthetic Practice is a dental practice providing private treatment for both adults and children.

The practice is situated in Emsworth, a village near Chichester, West Sussex. The practice has three dental treatment rooms and a separate decontamination room used for cleaning, sterilising and packing dental instruments. The practice is based on the ground and first floor. The ground floor is accessible to wheelchair users, prams and patients with limited mobility.

The practice employs three dentists, two hygienists, three dental nurses and a receptionist. The practice opening hours are 8.30am to 5.30pm Monday to Thursday and 8.30am to 3.00pm on Friday. There are arrangements in place to ensure patients receive urgent care and treatment assistance when the practice is closed.

The practice owner 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 inspection was carried out by a lead inspector.

Our key findings were:

• Staff had received safeguarding training appropriate to their roles.
• Staff recruitment files contained essential information in relation to Regulation 19, Schedule 3 of Health & Social Care Act 2008 (Regulated Activities) Regulations 2014.

We saw a well run and efficient dental practice where staff ensured that patients were well cared for and fully involved with their care and treatment. We noted that their care and treatment was planned to meet their needs in an environment which was clean and hygienic. We found the staff to be well trained and competent in their various roles and that patients' were protected by good management processes and accurate clinical records.

We carried out an announced comprehensive inspection on 21 March 2016 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

North Street Dental & Aesthetic Practice is a dental practice providing private treatment for both adults and children.

The practice is situated in Emsworth, a village near Chichester, West Sussex. The practice has three dental treatment rooms and a separate decontamination room used for cleaning, sterilising and packing dental instruments. The practice is based on the ground and first floor. The ground floor is accessible to wheelchair users, prams and patients with limited mobility.

The practice employs three dentists, two hygienists of whom one is a locum, three dental nurses and a receptionist. The practice opening hours are 8.30am to 5.30pm on Monday, Wednesday and Thursday and 8.30am to 2pm on Tuesday and Friday. There are arrangements in place to ensure patients receive urgent care and treatment assistance when the practice is closed.

The practice owner 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.

During our inspection we reviewed 25 CQC comment cards completed by patients and obtained the view of nine patients on the day of our inspection.

The inspection was carried out by a lead inspector and a dental specialist adviser.

Our key findings were:

• Staff had been trained to handle emergencies.

• Appropriate medicines and life-saving equipment was readily available in accordance with current guidelines.

• The treatment rooms in use and other public areas of the practice appeared clean and maintained.

• Infection control procedures followed published guidance.

• The practice had a safeguarding lead professional with processes in place for safeguarding adults and children living in vulnerable circumstances.

• Although the practice generally followed national guidance for radiation used in dental practice, the maintenance of the X-ray sets was not carried out in accordance with current Ionising Radiation Regulations 1999, one of the three X-ray sets had not been maintained in accordance with current guidelines. We have since received evidence to confirm this has been addressed.

• Staff reported accidents and kept records of these which the practice used for shared learning.

• Dentists provided dental care in accordance with current professional and National Institute for Care Excellence (NICE) guidelines.

• The service was aware of the needs of the local population and took these into account in how the practice was run.

• Patients could access treatment and urgent and emergency care when required.

• The practice did not have effective systems established to assess, monitor and mitigate the various risks arising from undertaking of the regulated activities. We have since received evidence to confirm risks relating to fire, legionella and the electrical wiring have been addressed.

• The practice reviewed and dealt with complaints according to their practice policy.

• Most staff received the training required to enable them to carry out their roles. Areas of concern included fire safety, safeguarding vulnerable adults and children and infection control training.

There were areas where the provider must:

• Ensure all relevant staff are up to date with their mandatory training and Continuing Professional Development (CPD).

• Ensure the practice recruitment policy and procedures are suitable 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.

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

• Review the practice protocols for managing a central log of staff training requirements and reviews.

• Consider installing a hearing loop and language interpreting facilities.

• Review the practice system for its policy management and ensure that policies have a review date to reflect changes to guidelines and government legislation.

• Consider providing the hygienist with the support of an appropriately trained member of the dental team.

• Review the protocols and procedures for the auditing of the quality of dental X-rays.

• Review the induction process for new staff to ensure records are maintained to confirm effective procedures are followed.