We carried out this focused inspection of Oak Tree Dental Practice to follow up concerns we originally identified during a comprehensive inspection at the practice on 28 September 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 areas 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 Oak Tree Dental Practice on our website www.cqc.org.uk.

This inspection was carried out on 27 February 2018 by a review of documents and other evidence sent to us from the provider as requested at our previous inspection.

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 some 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 adequate improvement to put right the shortfalls and deal with the regulatory breach we found at our inspection on 28 September 2016. The provider must ensure that the newly implemented improvements are embedded and sustained long-term in the practice.

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

• Review the practice’s sharps procedures and ensure the practice is in compliance with the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.

We carried out an announced comprehensive inspection on 28 September 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

Oak Tree Dental Practice has a principal dentist and four associate dentists, a dental hygienist; eight qualified dental nurses who are registered with the General Dental Council (GDC), a trainee dental nurse a practice manager and a receptionist. The practice’s opening hours are 8.30am to 5.30pm on Monday, Tuesday, Wednesday and Friday and 8.30am to 7.30pm on Thursday.

Oak Tree Dental Practice provides NHS and private dental treatment for adults and children. The practice has five dental treatment rooms on the ground floor. There is a separate decontamination room for cleaning, sterilising and packing dental instruments. There is also a reception, waiting area and patient toilet on the ground floor.

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 35 patients who provided a positive view of the services the practice provides. All of the patients commented that the quality of care was very good and staff were friendly and helpful.

Our key findings were

• Systems were in place for the recording of significant events and accidents although information recorded regarding outcomes, actions taken and lessons learned was brief.
• 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.
• The practice had not addressed all issues identified in the fire risk assessment such as fire marshal training. There were no records available to demonstrate maintenance or servicing of emergency lighting and staff were not recording monthly checks of emergency lighting or smoke detectors.
• The practice were not obtaining all information as per Schedule three of the Health and Social Care Act 2014.
• 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.
• Emergency equipment for dealing with medical emergencies mostly reflected published guidelines. We highlighted areas for improvement and these were all dealt with on the day of our visit
• Three staff had not completed annual update training regarding dealing with medical emergencies.
• The appointment system met the needs of patients and waiting times were kept to a minimum.

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

• Ensure that there are systems in place to assess and mitigate the risks to the health, safety and welfare of patients and staff. This includes procedures to:
• Ensure that the practice’s fire safety procedures and protocols are suitable including implementing robust procedures to ensure that all fire safety equipment is serviced and checked to demonstrate that this equipment is in good working order and addressing any issues identified in the practice’s fire risk assessment.
• Ensure that the practice’s infection control procedures and protocols are suitable 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’.
• Ensure the practice give due regard to guidelines issued by the Resuscitation Council (UK), and the General Dental Council (GDC) standards for the dental team regarding the availability of medicine and equipment to manage medical emergencies and by the provision of associated documentation to demonstrate that appropriate checks are made on this medicine and equipment. Ensure that staff training is up to date regarding basic life support.

• Ensure that the practice implements systems for the recording, investigating and reviewing of accidents or significant events

• Ensure that the practice gives due regard to the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.

• Ensure that the practice obtains all information in line with Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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

• Review the practice’s protocols for the use of rubber dam for root canal treatment giving due regard to guidelines issued by the British Endodontic Society.

• Review the security of prescription pads in the practice and ensure there are systems in place to monitor and track their use.

• Review the practice’s protocols for recording in the patients’ dental care records or elsewhere the reason for taking the X-ray and quality of the X-ray giving due regard to the Ionising Radiation (Medical Exposure) Regulations (IR(ME)R) 2000.

• Review the practice's protocols for completion of dental records giving due regard to guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.

The practice was located on the ground floor and was accessible to people who have restricted mobility. The premises consisted of a reception area, waiting room, five treatment rooms, a decontamination room, X-ray room and toilet facilities. A portable induction loop was available for patients with impaired hearing and television screens provided educational dental care guidance for patients.

The dental team consisted of five dentists, five dental nurses, a hygienist and a practice manager. We spoke with one dentist, one dental nurse, the decontamination nurse, the practice manager and three people who used the service.

People were informed of their treatment options and their consent was obtained prior to treatment. One person who used the service said, "The dentist always discusses treatment options for me or my children, they make sure I understand any risks or benefits”.

We saw that patient dental records contained clear information about people’s health history, the treatment they had received and a record of risks and benefits. Records showed that their treatment had been discussed with them.

We saw that the decontamination process was followed for the cleaning of dental instruments to reduce the risk of cross infection.

The staff recruitment practices ensured that all staff were suitable to work at the surgery.

People had access to a complaints procedure for the practice and we found that complaints were treated seriously and acted upon.