We undertook a focused inspection of Oracle Dental Clinics Shrewsbury on 26 November 2018. This inspection was carried out to review in detail the actions taken by the registered provider to improve the quality of care and to confirm that the practice was now meeting legal requirements.

The inspection was led by a CQC inspector who was supported by a specialist dental adviser.

We undertook a comprehensive inspection of Oracle Dental Clinics Shrewsbury on 26 June 2017 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We found the registered provider was not providing well led care and was in breach of regulation 17 Good Governance 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 Oracle Dental Clinics Shrewsbury on our website www.cqc.org.uk.

When one or more of the five questions are 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. We undertook a focused inspection on the 19 March 2018 to ascertain whether the provider had addressed the issues raised. We found that whilst most of the issues had been addressed there were some issues that we were not shown evidence of actions taken. Following this a further focussed inspection was completed on the 26 November 2018.

As part of this inspection we asked:

• Is it well-led?

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 in relation to the regulatory breach we found at our inspections on 26 June 2017 and again on 19 March 2018.

Background

Oracle Dental Clinics Shrewsbury provides private treatment to patients of all ages.

There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces, including those for patients who are blue badge holders, are available near the practice.

The dental team includes eight dentists, one orthodontist, five dental nurses (two of whom are trainee dental nurses), one dental hygienist, the practice manager and one receptionist. The practice has three treatment rooms.

The practice is owned by a company and as a condition of registration must have a person registered with the Care Quality Commission as the registered manager. Registered managers 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 registered manager at Oracle Dental Clinics Shrewsbury is the practice manager. A registered manager is legally responsible for the delivery of services for which the practice is registered.

During the inspection we spoke with the principal dentists, the area manager and the practice manager. We looked at staff recruitment files, staff training files and patient clinical care records.

The practice is open: 9am to 5pm Monday, Wednesday, Thursday and Friday and 8.30am to 7pm on Tuesday. The practice is closed for lunch for one hour each day between 1pm and 2pm.

Our key findings were:

• The practice had implemented effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

We carried out a focused inspection of Oracle Dental Clinics Shrewsbury on 19 March 2018.

The inspection was led by a CQC inspector who was supported by a specialist dental adviser.

We carried out the inspection to follow up concerns we originally identified during a comprehensive inspection at this practice on 26 June 2017 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions and to check on information we received following the inspection of 26 June 2017 relating to this aspect of care at this practice.

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 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 Oracle Dental Clinics Shrewsbury on our website www.cqc.org.uk.

The provider had failed to address issues we had raised in our previous report; the provider must ensure action is taken to address all outstanding issues. We identified regulations the provider was not meeting. They must:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care

Full details of the regulation the provider is not meeting is at the end of this report.

There were areas where the provider could make improvements. They should:

• Review the practice's protocols and procedures for the use of laser equipment in compliance with The Medicines and Healthcare Regulatory Agency (MHRA) Lasers, intense light source systems and LEDs- guidance for safe use in medical, surgical, dental and aesthetic practices (September 2015).

Our findings were:

Are services well-led?

We found the practice was not providing well-led care in accordance with relevant regulations.

The provider had made insufficient improvements to put right the shortfalls and had not dealt with the regulatory breach we found at our inspection on 26 June 2017.

In response to concerns raised to the CQC we carried out this unannounced inspection on 26 June 2017 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We planned the inspection to check whether the registered provider was meeting the legal requirements in the Health and Social Care Act 2008 and associated regulations. The inspection was led by a CQC inspector who was supported by a specialist dental adviser.

To get to the heart of patients’ experiences of care and treatment, we always ask the following five questions:

• Is it safe?

• Is it effective?

• Is it caring?

• Is it responsive to people’s needs?

• Is it well-led?

These questions form the framework for the areas we look at during the inspection.

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

Oracle Dental Clinic is in Shrewsbury and provides private treatment to patients of all ages.

There is level access for people who use wheelchairs and pushchairs. Car parking spaces, including those for patients with disabled badges, are available near the practice.

The dental team includes five dentists, one orthodontist, three dental nurses, one dental hygienist, the practice manager and one receptionist. A consultant anaesthetist who also works at the local hospital works on an as needed basis at the practice to provide sedation to patients. The practice has three treatment rooms.

The practice is owned by a company and as a condition of registration must have a person registered with the Care Quality Commission as the registered manager. Registered managers 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 registered manager at Oracle Dental Clinic Shrewsbury is the practice manager who started working at this practice in October 2016.

On the day of inspection we did not collect any CQC comment cards filled in by patients as this inspection was unannounced. We spoke with one patient during the inspection. This information gave us a positive view of the practice.

During the inspection we spoke with one dentist, one dental nurse, the receptionist and the practice manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open: 9am to 5pm Monday, Wednesday, Thursday and Friday and 8.30am to 7pm on Tuesday. The practice is closed for lunch for one hour each day between 1pm and 2pm.

Our key findings were:

• The practice was clean and well maintained.
• The practice had infection control procedures which reflected published guidance.
• Not all staff had received up to date training on how to deal with medical emergencies. Appropriate medicines and life-saving equipment were available, although one medicine and one piece of equipment was out of date. These were disposed of and new ones ordered immediately following this inspection.
• The practice had some systems to help them manage risk and improvements were being made to risk assessment processes.
• The practice manager had provided safeguarding training to staff and staff knew their responsibilities for safeguarding adults and children.
• It was difficult to identify if the practice had thorough staff recruitment procedures as information was not available on the day of inspection, nor provided immediately following the inspection. We asked for but were not provided with evidence to demonstrate that a DBS check had been completed on all clinical staff.
• Not all patient dental care records we were shown evidenced that patients had been given a treatment plan, had signed consent documentation or that details of risks and benefits of treatment had been discussed with them.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• We identified some dental materials in treatment rooms which were out of date. Staff had been completing check sheets but had failed to identify these out of date materials in two treatment rooms checked.
• The appointment system met patients’ needs.
• The practice manager started working at the practice in October 2016 and had identified issues that required acting upon. Staff told us that there had been improvements recently at the practice and they felt involved and supported.
• The practice asked patients for feedback about the services they provided.
• The practice was in the process of implementing complaint recording and handling systems. We were shown details of one recent complaint which had been dealt with efficiently.

We identified regulations the provider was not meeting. They must:

• Ensure effective systems are in place in order that the regulated activities at Oracle Dental Clinics Shrewsbury are complaint with the requirements of Regulations 4 to 20A of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Particular reference is made to staff recruitment and ongoing training audit processes, patient care records, systems for monitoring and mitigating risk and maintenance of equipment.