We undertook a follow up focused inspection of P & J Noble Dental Practice on 7 March 2019. 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 had remote access to a specialist dental adviser.

We undertook a comprehensive inspection of P & J Noble Dental Practice on 12 December 2018 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 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 P & J Noble Dental Practice on our website www.cqc.org.uk.

As part of this inspection we asked:

• Is it well-led?

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.

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 inspection on 12 December 2018.

Background

P & J Noble Dental Practice is in Greenfield, Oldham and provides NHS and private treatment to adults and children. The practice is also contracted to provide NHS orthodontic treatment.

The premises has steps to the front and rear of the premises making it inaccessible to wheelchair users. A car park is available behind the premises, including spaces for blue badge holders.

The dental team includes the principal dentist, an associate dentist and an orthodontist who attends as required, four dental nurses, a dental hygienist, a practice manager and a receptionist. The practice has three treatment rooms.

The practice is owned by a partnership 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 P & J Noble Dental Practice is the principal dentist.

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

The practice is open:

Monday and Tuesday 9am to 1pm and 2pm to 7pm,

Wednesday 9am to 1pm and 2pm to 6pm,

Thursday and Friday 9am to 1pm and 2pm to 5pm.

Our key findings were:

• The autoclaves and washer disinfector had been serviced and validated. A system had been implemented to ensure equipment was maintained appropriately.
• A system had been implemented to receive patient safety and medicines alerts from the MHRA.
• The sharps risk assessment had been updated to include the risks from other sharp instruments.
• Advice had been sought about members of clinical staff who were low responders to the Hepatitis B vaccination.

We carried out this announced inspection on 12 December 2018 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

P & J Noble Dental Practice is in Greenfield, Oldham and provides NHS and private treatment to adults and children. The practice is also contracted to provide NHS orthodontic treatment.

The premises has steps to the front and rear of the premises making it inaccessible to wheelchair users. A car park is available behind the premises, including spaces for blue badge holders.

The dental team includes the principal dentist, an associate dentist and an orthodontist who attends as required, four dental nurses, a dental hygienist, a practice manager and a receptionist. The practice has three treatment rooms.

The practice is owned by a partnership 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 P & J Noble Dental Practice is the principal dentist.

On the day of inspection, we collected 48 CQC comment cards filled in by patients. Patients were positive about all aspects of the service the practice provided.

During the inspection we spoke with the principal and associate dentists, dental nurses, the dental hygienist, 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:

Monday and Tuesday 9am to 1pm and 2pm to 7pm,

Wednesday 9am to 1pm and 2pm to 6pm,

Thursday and Friday 9am to 1pm and 2pm to 5pm.

Our key findings were:

• The premises were clean, tidy and well maintained.
• The provider had infection control procedures which reflected published guidance.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• The systems to identify and manage risk required improvement.
• The practice staff had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
• The provider had thorough staff recruitment procedures.
• The clinical staff provided patients’ care and treatment in line with current guidelines.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• The provider was providing preventive care and supporting patients to ensure better oral health.
• The appointment system met patients’ needs.
• Staff felt involved and supported and worked well as a team.
• The practice asked staff and patients for feedback about the services they provided.
• The provider had systems to deal with complaints positively and efficiently.
• The provider had suitable information governance arrangements.

We identified regulations the provider was not complying with. 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 are at the end of this report.