We undertook a follow up focused inspection of Poundswick Lane Dental Practice on 15 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 carried out by a CQC inspector.

We undertook a comprehensive inspection of Poundswick Lane Dental Practice on 28 June 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 in accordance with the relevant regulations 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 Poundswick Lane Dental Practice 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.

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 inspection on 28 June 2018.

Background

Poundswick Lane Dental Practice is in Wythenshawe and provides NHS and private treatment to adults and children.

A ramp is provided for people who use wheelchairs and those with pushchairs. There is a small car park available with additional on street parking available near the practice.

The dental team includes nine dentists, nine dental nurses (two of whom are trainees), a dental hygienist and a receptionist. The practice has five treatment rooms.

The practice is owned by an individual who is the principal dentist there. They 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 the inspection we spoke with the practice manager, and dental nurses including the senior dental nurse. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday, Tuesday and Wednesday 9am to 6pm

Thursday and Friday 9am to 5pm

Saturday by prior arrangement.

Our key findings were:

• The practice had infection control procedures which reflected published guidance. The processes for manually cleaning instruments could be improved.
• The practice had thorough staff recruitment procedures. Staff files had been reviewed and now contained all the required information, including vaccination immunity.
• The practice had effective leadership and a culture of continuous improvement.
• Emergency equipment and medicines were available as described in recognised guidance.
• The safety and use of radiography had been reviewed.
• The practice had improved safeguarding training processes.
• The practice had systems to identify and manage risk effectively. Improvements had been made in relation to hazardous substances, Legionella and fire safety.

We carried out this announced inspection on 28 June 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

Poundswick Lane Dental Practice is in Wythenshawe and provides NHS and private treatment to adults and children.

A ramp is provided for people who use wheelchairs and those with pushchairs. On street parking is available near the practice.

The dental team includes nine dentists, ten dental nurses (three of whom are trainees), a dental hygienist, two receptionists (one of whom is a trainee), a practice manager and a business and finance manager. The practice has five treatment rooms.

The practice is owned by an individual who is the principal dentist there. They have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run.

On the day of inspection, we collected 34 CQC comment cards filled in by patients.

During the inspection we spoke with three dentists, three dental nurses, 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, Tuesday and Wednesday 9am to 6pm

Thursday and Friday 9am to 5pm

Saturday by prior arrangement.

Our key findings were:

• The practice appeared clean and well maintained.
• The practice staff had infection control procedures which reflected published guidance.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• The practice had systems to help them manage risk.
• The practice staff had suitable safeguarding processes and knew their responsibilities for safeguarding adults and children.
• The practice 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 practice was providing preventive care and supporting patients to ensure better oral health.
• The appointment system met patients’ needs.
• The practice had effective leadership and culture of continuous improvement.
• 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 practice staff dealt with complaints positively and efficiently.
• The practice staff had suitable information governance arrangements.

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 are at the end of this report.

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

• Review the practice’s protocols for the use of closed circuit television cameras taking into account the guidelines published by the Information Commissioner's Office (ICO).

• Review the practice’s consent policy to ensure it includes the requirements of the Mental Capacity Act 2005 and Gillick competency.

• Review the practice’s arrangements for receiving and responding to patient safety alerts, recalls and rapid response reports issued by the Medicines and Healthcare products Regulatory Agency, the Central Alerting System and other relevant bodies, such as Public Health England.

Patients told us they were given good information about treatment options and costs before having to make any decision about their treatment.

We found that patients consent was always obtained before the commencement of treatment.

Patients told us that the dentists always asked them at the start of their examination and or treatment if there had been any changes in their health since their last appointment and if they were on any medication. This meant that staff working at the practice ensured that they had up to date and accurate medical information before they treated patients.

Patients we spoke with told us that surgeries were always clean and that dental and nursing staff always wore and used personal protective equipment whilst they were being treated.

We observed that surgery and patient waiting areas were clean and measures were in place that ensured a good standard of infection control.

We found that comments and feedback from patients were taken seriously by the registered provider and practice manager and this was used to make changes and improvements to how the service was delivered.