We carried out a follow up inspection on 12 December 2017 at Prescot House Dental Surgery.

On 22 March 2017 we undertook an announced comprehensive inspection of this service as part of our regulatory functions. During this inspection we found a breach of the legal requirements.

A copy of the report from our comprehensive inspection can be found by selecting the 'all reports' link for Prescot House Dental Surgery on our website at www.cqc.org.uk.

After the comprehensive inspection, the practice wrote to us to say what they would do to meet the legal requirements in relation to the breach.

We revisited Prescot House Dental Surgery on 18 October 2017 to confirm whether they had followed their action plan, and to check whether they met the legal requirements in the Health and Social Care Act 2008 and associated regulations. During this inspection we found breaches of the legal requirements.

A copy of the report from our follow-up inspection can be found by selecting the 'all reports' link for Prescot House Dental Surgery on our website at www.cqc.org.uk.

After the follow-up inspection, the practice wrote to us to say what they would do to meet the legal requirements in relation to the breaches.

We revisited Prescot House Dental Surgery on 12 December 2017 to confirm whether they had followed their action plan, and to check whether they met the legal requirements in the Health and Social Care Act 2008 and associated regulations. This report only covers our findings in relation to those requirements.

We carried out the announced inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions.

We reviewed the practice against oneof the five questions we ask about services: is the service well-led?

The inspection was led by a CQC inspector who had remote access to a specialist dental adviser.

Our findings were:

Are services

well-led

?

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

Background

Prescot House Dental Surgery is close to the centre of Prescot and provides dental care and treatment to adults and children on an NHS or privately funded basis.

There are steps at the front entrance to the practice with a handrail positioned alongside to assist patients with limited mobility. The provider has installed a ramp to facilitate access to the practice for wheelchair users. The practice has five treatment rooms. Car parking is available near the practice.

The dental team includes a principal dentist, four associate dentists, a dental hygienist and eight dental nurses, some of whom also carry out reception duties. The team is supported by a practice manager.

The practice is owned by a partnership and as a condition of registration must have in place a person registered with the Care Quality Commission as the registered manager. Registered managers have a 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 Prescot House Dental Surgery is the practice manager.

The practice is open:

Monday, Tuesday, Thursday and Friday 9.00am to 5.30pm

Wednesday 9.00am to 8.00pm

Occasional Saturdays 9.00am to 1.00pm

Our key findings were:

• The practice had improved their systems in relation to recruitment, medical emergencies, stock control of dental materials, and training. We found these were operating effectively.
• We found risks were appropriately managed specifically in relation to the Hepatitis B immunisation status of the clinical staff.
• The practice had improved their arrangements for communicating feedback to staff and patients.

We carried out an announced comprehensive inspection on 22 March 2017 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

Prescot House Dental Surgery is located near the centre of Prescot. The practice comprises a reception and waiting room, five treatment rooms, an X-ray room, a decontamination room and patient toilet facilities. The practice also has a dental laboratory facility on the premises. Parking is available near the practice. The practice is accessible to patients with disabilities, limited mobility, and to wheelchair users.

An external ramp facilitates access to the premises for wheelchair users and people with pushchairs. Closed circuit television monitoring is in place at the premises externally and internally in the reception, waiting room, records room and one of the staff rooms.

The practice provides general dental treatment to patients on an NHS or privately funded basis. The opening times are Monday, Tuesday, Thursday and Friday 9.00am to 5.30pm, Wednesday 9.00am to 8.00pm and Saturday 9.00am to 1.00pm. The practice is staffed by a principal dentist, a practice manager, three associate dentists and eight dental nurses who also carry out reception duties.

The practice manager 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 received feedback from 29 people during the inspection about the services provided. Patients commented that they found the practice excellent, and that staff were professional, friendly, and caring. They said the dentists carefully listened to them and they were always given good and helpful explanations about dental treatment. Patients commented that the practice was clean and comfortable and they were always accommodated in an emergency.

Our key findings were:

• The practice had procedures in place to record, analyse and learn from significant events and incidents.
• There were sufficient numbers of suitably qualified and skilled staff to meet the needs of patients.
• The premises were clean, secure and well maintained.
• Patients’ needs were assessed, and care and treatment were delivered, in accordance with current standards and guidance.
• Patients received information about their care, proposed treatment, costs, benefits, and risks and were involved in making decisions about it.
• Staff were supported to deliver effective care, and opportunities for training and learning were available.
• Patients were treated with kindness and respect, and their confidentiality was maintained.
• Appointments were available at a variety of times of the day.
• The practice gathered and took account of the views of patients.
• Staff were supervised and worked together as a team.
• Governance arrangements were in place for the running of the practice. Not all of these were operating effectively.
• Staff had received safeguarding training, and knew the processes to follow to raise concerns, but there was no practice specific policy to guide them.
• Staff had been trained to deal with medical emergencies. Not all recommended emergency medicines and equipment were available.
• Infection control arrangements were in place but improvements were needed to these.

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

• Ensure the practice’s infection control procedures and protocols are suitable having 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 that systems and processes are established and operated effectively, to safeguard patients from abuse, and to allow staff to raise concerns.
• Ensure the systems and processes for managing medical emergencies are operated effectively having due regard to guidelines issued by the British National Formulary, the Resuscitation Council (UK), and the General Dental Council standards for the dental team.
• Ensure the practice's recruitment procedures are suitable and the recruitment arrangements are in accordance with Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 to ensure the necessary employment checks are identified for all staff and the required specified information in respect of persons employed by the practice is available.
• Ensure an effective system is established to assess, monitor and mitigate the various risks arising from undertaking of the regulated activities, including those in relation to sharps and staff immunisation.

You can see full details of the regulations not being met at the end of this report.

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

• Review stocks of medicines and equipment and the system for identifying and disposing of out-of-date stock.
• Review the practice’s waste handling procedures to ensure waste is disposed of in accordance with the relevant regulations having due regard to guidance issued in the Health Technical Memorandum 07-01.
• Review staff awareness of the requirements of the Mental Capacity Act 2005 and ensure all staff are aware of their responsibilities under the Act as it relates to their role.
• Review the complaints procedure to ensure details of alternative organisations to which patients can complain are readily available.
• Review the practice’s protocols in relation to the use of closed circuit television to ensure staff and patients are fully informed as to its purpose and their right to access footage.
• Review the practice’s audit protocols to ensure audits, such as radiography and infection control, are undertaken at regular intervals to help improve the quality of service. The practice should also ensure all audits have documented learning points which are shared with staff and the resulting improvements can be demonstrated.

We spoke with three people who used the service. They were very satisfied with the treatment they had received. They told us they were given options about their treatment when they visited the dentist and that the dentists explained different treatment options that were available and what the treatment entailed.

People told us the service had been professional, reliable and friendly and that they felt the dentists and dental nurses were skilled. We observed good rapport between the people who used the service and staff.

People told us they had signed documentation to give their consent to treatment and that staff checked peoples' medical histories and medication. People told us they found the surgery to be clean and hygienic and that staff had high standards of cleanliness and infection control. When we looked around the practice we saw evidence that the premises were kept clean. We also saw evidence of effective infection control systems in place.

We also saw evidence that the dentists and dental nurses had been professionally trained to the level their positions required. We also saw that they had completed training in other appropriate courses. We saw evidence that there was a quality assurance system in place that informed the future performance of the service.

We carried out a follow up inspection on 18 October 2017 at Prescot House Dental Surgery.

On 22 March 2017 we undertook an announced comprehensive inspection of this service as part of our regulatory functions. During this inspection we found a breach of the legal requirements.

A copy of the report from our comprehensive inspection can be found by selecting the 'all reports' link for Prescot House Dental Surgery on our website at www.cqc.org.uk.

After the comprehensive inspection, the practice wrote to us to say what they would do to meet the legal requirements in relation to the breach. This report only covers our findings in relation to those requirements.

We revisited Prescot House Dental Surgery on 18 October 2017 to confirm whether they had followed their action plan, and to confirm that they now met the legal requirements in the Health and Social Care Act 2008 and associated regulations. We carried out this unannounced inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions.

We reviewed the practice against oneof the five questions we ask about services: is the service well-led?

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

Our findings were:

Are services

well-led

?

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

Background

Prescot House Dental Surgery is close to the centre of Prescot and provides dental care and treatment to adults and children on an NHS or privately funded basis.

There are steps at the front entrance to the practice with a handrail positioned alongside to assist patients with limited mobility. The provider has installed a ramp to facilitate access to the practice for wheelchair users. The practice has five treatment rooms. Car parking is available near the practice.

The dental team includes a principal dentist, four associate dentists, a dental hygienist and eight dental nurses, some of whom also carry out reception duties. The team is supported by a practice manager.

The practice is owned by a partnership and as a condition of registration must have in place a person registered with the Care Quality Commission as the registered manager. Registered managers have a 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 Prescot House Dental Surgery is the practice manager.

The practice is open:

Monday, Tuesday, Thursday and Friday 9.00am to 5.30pm

Wednesday 9.00am to 8.00pm

Occasional Saturdays 9.00am to 1.00pm

Our key findings were:

• The practice had improved their infection control procedures.
• We found that the practice had reviewed their safeguarding and whistleblowing processes and made them specific to the practice.
• The practice had improved their procedure for dealing with complaints.
• The practice had systems in place in relation to recruitment, medical emergencies, stock control of dental materials, and training. We found these were not operating effectively and had not been improved since our initial inspection.
• We found not all risks were appropriately managed particularly in relation to the Hepatitis B immunisation status of the clinical staff.

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.
• Ensure recruitment procedures are operated effectively to ensure only fit and proper persons are employed.

Full details of the regulations the provider was not meeting are at the end of this report.

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

• Review the practice’s protocols in relation to the use of closed circuit television to ensure staff and patients are fully informed as to its purpose and their right to access footage.
• Review the practice’s audit protocols of various aspects of the service such as radiography to help improve the quality of service. The practice should also ensure all audits have documented learning points, where relevant, and the resulting improvements can be demonstrated.