We carried out this announced inspection on 2 May 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 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 providing well-led care in accordance with the relevant regulations.

Background

Pulteney Dental Practice is in Bath and provides NHS and private treatment to patients of all ages.

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

The dental team includes five dentists, one orthodontist, two dental nurses, one trainee dental nurse, three dental hygienists, one cleaner and one receptionist. The practice has four 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. The registered manager at Pulteney Dental Practice was the principal dentist.

On the day of inspection we collected 21 CQC comment cards filled in by patients and spoke with five other patients.

During the inspection we spoke with three dentists, two dental nurses and one trainee dental nurse. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday to Friday 8.30am to 5pm

Our key findings were:

• The practice appeared clean and maintained.
• The practice 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 had suitable safeguarding processes and staff 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 dealt with complaints positively and efficiently.
• The practice had suitable information governance arrangements.

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

• Review the practice's policy and the storage of products identified under Control of Substances Hazardous to Health (COSHH) 2002 Regulations to ensure a risk assessment is undertaken and the products are stored securely.
• Review the practice’s sharps procedures to ensure the practice is in compliance with the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.
• 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.
• Review the training, learning and development needs of individual staff members at appropriate intervals and ensure an effective process is established for the on-going assessment, supervision and appraisal of all staff.

We carried out an announced responsive follow up inspection on 13 December 2016 to ask the practice the following key questions; Are services safe; are they caring and are they well-led?

Our findings were:

Are services safe?

We found this practice was providing safe care in accordance with the relevant regulations.

Are services caring?

We found this practice was providing caring services in accordance with the relevant regulations.

Are services well-led?

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

Background

Pulteney Dental Practice is a dental practice is a long established a dental practice in the centre of Bath providing NHS and some private dental treatment and caters for both adults and children. The practice has three dental treatment rooms, a reception and waiting area. The practice is accessed by a flight of stairs with no facilities on the ground floor or enabling access for patients with limited mobility. The provider has an arrangement with another dentist locally that has accessible facilities.

The practice has five dentists, four hygienists and two dental nurses who are supported by one receptionist. The practice’s opening hours are 8:30am – 5:00pm Monday to Friday. For out of hours service patients are directed to ring 111.

At the time of inspection the provider was the registered manager and was available in the practice three days a week to provide leadership at this location. 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.

Since the last inspection the practice had appointed a practice manager who has implemented governance systems and processes and worked with the provider to improve the management of the service.

At the last inspection we found the practice was non-compliant and had issued them with warning notices in respect of care and treatment and good governance and a requirement notice regarding dignity and respect.

We carried out an announced responsive follow up inspection on 13 December 2016 to check the provider had taken action to address the areas of non-compliance and was now providing a safe and quality monitored service. The inspection took place over one day and was carried out by a lead inspector with remote specialist dental advice.

We obtained feedback about the practice from three patients we spoke with during the inspection and 11 NHS Friends and Family Test feedback cards. The patients we spoke with and the feedback seen were very complimentary about the service. They told us they found the practice and staff provided good care; were friendly and welcoming and all patients felt they were treated with dignity and respect.

Our key findings were:

• The patients we spoke with indicated they were treated with kindness and respect by staff. We observed good communication with patients and their families.

• We were told access to the service and to the dentists, was good. Patients reported good access to the practice with emergency appointments available within 24 -48 hours.

• There were systems in place to help ensure the safety of staff and patients. These included safeguarding children and adults from abuse, maintaining the required standards of infection prevention and control and responding to medical emergencies.

• The dental practice had effective clinical governance and risk management processes in place; including health and safety and the management of medical emergencies.

• Patient care and treatment was delivered in line with evidence-based guidelines, best practice and current legislation. Patient dental records were electronic, detailed and comprehensive.

• The practice had a comprehensive system to monitor and continually improve the quality of the service; including through a detailed programme of clinical and non-clinical audits.

• Use of Loupes – these enable the clinician to have a magnified view of the operation site thus enabling extreme accuracy of treatment.

• The use of digital radiographs to help explain necessary treatment to patients while in the chair.

• Premises appeared well maintained and visibly clean. Good cleaning and infection control systems were in place. The treatment rooms were well organised and equipped, with good light and ventilation.

• There were systems in place to check all equipment had been serviced regularly, including the air compressor, autoclave, fire extinguishers, oxygen cylinder and the X-ray equipment.

• There were sufficient numbers of suitably qualified staff who maintained the necessary skills and competence to support the needs of patients.

• Staff were up to date with current guidelines, supported in their professional development and the practice was led by a proactive new principal dentist.

• The practice was meeting the Essential Quality Requirements of the Department of Health guidance, namely 'Health Technical Memorandum 01-05 - Decontamination in primary care dental practices (HTM 01-05)' national guidance for infection prevention control in dental practices.

• The management of sharps was in accordance with the current EU regulations with respect to safer sharps (Health and Safety Sharp instruments in Healthcare Regulations 2013).

• There were systems in place to learn and improve from incidents or healthcare alerts.

• Appropriate recruitment processes and checks were undertaken in line with the relevant recruitment regulations and guidance for the protection of patients.
• Patients privacy and dignity was respected and maintain at all times.

We carried out an announced comprehensive inspection on 7 December 2015 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 this practice was not providing safe care in accordance with the relevant regulations.

Are services effective?

We found this practice was providing effective care in accordance with the relevant regulations

Are services caring?

We found this practice was not providing caring services in accordance with the relevant regulations.

Are services responsive?

We found this practice was providing responsive care in accordance with the relevant regulations.

Are services well-led?

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

Background

Pulteney Dental Practice is a dental practice is a long established a dental practice in the centre of Bath providing NHS and some private dental treatment and caters for both adults and children. The practice has three dental treatment rooms, a reception and waiting area. The practice is accessed by a flight of stairs with no facilities on the ground floor or enabling access for patients with limited mobility. The provider has an arrangement with another dentist locally that has accessible facilities.

The practice has five dentists, four hygienists and two dental nurses who are supported by one receptionist. The practice’s opening hours are 9:00am – 5:00pm Monday to Friday. For out of hours service patients are directed to ring 111.

At the time of inspection the provider was the registered manager and was available in the practice three days a week to provide leadership at this location. 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. However the practice did have an appointed practice manager but they were not present on the day of inspection.

We carried out an announced comprehensive inspection on 7 December 2015 because we had received information from NHS England regarding concerns about the service provided at this practice by the previous dentist and provider. The inspection took place over one day and was carried out by a lead inspector and a specialist dental advisor.

We obtained feedback about the practice from 19 completed Care Quality Commission comment cards and speaking with eight patients during the inspection. The patients we spoke with were complimentary about the service. They told us they found the practice and staff provided good care; were friendly and welcoming and all patients felt they were treated with dignity and respect. Two patients told us they often had to wait for their appointments and were kept informed during the period of waiting.

Our key findings were:

• The patients we spoke with indicated they were treated with kindness and respect by staff. We observed good communication with patients and their families, access to the service and to the dentists, was good. Patients reported good access to the practice with emergency appointments available within 24 -48 hours.
• There were systems to check equipment had been serviced regularly, including the compressor, autoclave, fire extinguishers, oxygen cylinder and the X-ray equipment.
• The practice was not meeting the Essential Quality Requirements of the Department of Health guidance, namely 'Health Technical Memorandum 01-05 - Decontamination in primary care dental practices (HTM 01-05)' national guidance for infection prevention control in dental practices.
• There was no clear designated lead professional for infection prevention and control. The provider had not addressed the environmental shortfalls in meeting the minimum standards.

• The management of sharps was not in accordance with the current EU regulations with respect to safer sharps (Health and Safety Sharp instruments in Healthcare Regulations 2013).

• There were no systems in place to learn and improve from incidents or healthcare alerts.

• There was no evidence of any recent audits being undertaken at the dental practice.

• Appropriate recruitment processes and checks were not undertaken in line with the relevant recruitment regulations and guidance for the protection of patients.

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

• Ensure the practice fully meets the Essential Quality Requirements of the Department of Health guidance, namely 'Health Technical Memorandum 01-05 - Decontamination in primary care dental practices (HTM 01-05)' as soon as is practically possible.
• Ensure dental sharps are managed in accordance with the current Health and Safety Sharp instruments in Healthcare Regulations 2013 and staff are appropriately trained.
• Provide training and competency assessment for staff about infection prevention and control and ensure all processes adhere to the national guidance HTM 01-05.
• Ensure appropriate systems are in place to meet health and safety regulations including risk assessment and the reporting and management of accident and incident reporting.
• Plan and implement a system of clinical audits as soon as practically possible for infection control, dental X-rays, clinical record keeping and other such audits as expected by the General Dental Council standards and as advised by the Faculty of General Dental Practice .
• Provide clear leadership, management and governance of the practice and assess service delivery to assure the delivery of quality, patient centred treatment and care, supported by learning and innovation, and promote an open and fair culture.
• Ensure patients privacy and dignity is respected at all times.
• Implement a system whereby all accidents and incidents are appropriately reported and managed for the safety of patients and staff.
• Ensure records of identification checks are included in staff recruitment files and use current DBS checks.
• Review staff awareness of the requirements of the Mental Capacity Act (MCA) 2005 and ensure all staff are aware of their responsibilities under the Act as it relates to their role.