We carried out an announced inspection of this practice on 30 June 2015. Breaches of legal requirements were found. After the inspection, the practice wrote to us to say what they would do to meet legal requirements in relation to well led care.

We undertook this focused inspection to check they had followed their plan and to confirm they had now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Norton Village Dental on our website at www.cqc.org.uk.

Our findings were:

Are services well led?

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

Background

The practice offers both NHS and private treatments. The NHS contract only extended to children. The staff structure at the practice includes the principal dentist, three dental nurses (one of which was a trainee, one worked as the practice manager and one was the lead nurse), and a dental hygiene therapist.

The practice is open:

Monday 9:00am to 6:30pm

Tuesdays to Thursday from 9.00am to 5.30pm

Friday 9.00am to 5.00 pm.

One Saturday per month the practice is open 10.00 am to 1.00pm.

The practice has two treatment rooms, both on the first floor along with a dedicated decontamination room and patient toilet. The reception and waiting area are on the ground floor. The practice is not accessible to patients with restricted mobility. The practice refers patients to neighbouring practices for treatments that have wheelchair access.

The practice offers a mix of NHS and private dental treatments including preventative advice, routine restorative dental care, private orthodontic treatments and dental implants.

The principal dentist is registered with the Care Quality Commission (CQC) as an individual registered person. 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.

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’.
• The practice had established an effective system to assess, monitor and mitigate the risks relating to the health, safety and welfare of patients, staff and visitors.
• The practice had implemented governance arrangements including the effective use of risk assessments, audits, such as those for infection control, and radiographs.
• All staff meetings were now minuted for monitoring and improving the quality of the care received.
• Changes had been made to the premises to ensure they were clutter free and fit for purpose.
• The fridge that stored medicines now had a temperature check record in place.

We carried out an announced comprehensive inspection on 30 June 2015 to ask the practice the following key questions; Are services safe, effective, caring, responsive and well-led?

The practice offers both NHS and private treatments. The NHS contract only extended to children. The staff structure at the practice includes the principal dentist (male) two fully qualified dental nurses, and a dental therapist/hygienist (all female). There is also a practice manager, who also covers the reception duties.

The practice is open from 9.00am to 6.30pm Monday, Tuesdays to Thursday from 9.00am to 5.30pm and on Friday 9.00am to 5.00 pm. One Saturday per month the practice is open10.00 am to1.00pm. The practice is closed each day for lunch.

The practice is housed in a converted residential property and across two floors. There are two treatment rooms, both on the first floor along with a dedicated decontamination room and patient toilet. The reception and waiting area are on the ground floor. The practice is not accessible to patients with restricted mobility. The practice offers domiciliary visits to these patients and also offers treatment in the waiting area when the practice is closed. The practice will also refer patients to neighbouring practices for treatments that have disabled access.

The principle dentist 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 seven patients on the day of our inspection and reviewed seven CQC comment cards that had been completed by patients they reflected positive views about the care and treatment they had received. Patients felt the dentist, nurses and hygienist took a lot of time to explain care and treatment options in a way they understood. Common themes were patients felt they received excellent care and they were provided with personal and compassionate services. All patients commented positively about the care and treatment they had received and the friendly, polite and professional staff.

We found this practice was providing safe, effective, caring, and responsive care in accordance with the relevant regulations. We found concerns in the area of providing well led services in relation to leadership.

Our findings were:

• Patients’ needs were assessed and care was planned in line with best practice guidance such as from the National Institute for Health and Care Excellence (NICE).
• There was a system in place for when mistakes might be made, patients would receive an apology and would be informed of any actions taken following an investigation.
• There was promotion of patient education to ensure good oral health.
• The appointment system met the needs of patients and waiting times were kept to a minimum.
• The practice had an accessible and visible leadership team. Staff on duty told us they felt supported by the leadership team.
• The practice sought feedback from staff and patients about the services they provided.
• The practice maintained appropriate dental care records and patients’ clinical details were updated appropriately.
• Governance systems were not effective.
• Audits were being undertaken but action plans were not established follow these.
• Infection control was not being maintained.
• Employment checks did not follow the recruitment policy.

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

• Review their infection 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’.

• Establish an effective system to assess, monitor and mitigate the risks relating to the health, safety and welfare of patients, staff and visitors.
• Review governance arrangements including the effective use of risk assessments, audits, such as those for infection control, radiographs and dental care records
• Record staff meetings for monitoring and improving the quality of the care received.
• Review the suitability of all areas of the premises and the fixtures and fittings in the treatment room.
• Ensure medicines that require storage in a fridge follow national guidance.
• Ensure all areas of the practice are kept clear of clutter.

On the day of the visit the provider had cancelled all appointments so we were unable to talk to patients. From the surveys, we looked at, people said that they were happy with the service provided. They felt their dignity was maintained and their privacy protected. The provider said results had been collated and that the outcome would be displayed in the reception area.