We undertook a follow up focused inspection of Queensway Dental Practice on 26 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 was supported by a specialist dental adviser.

We undertook a comprehensive inspection of Queensway Dental Practice on 5 July 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 regulations 17 and 19 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 Queensway 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 (requirement notice only). We then inspect again after a reasonable interval, focusing on the area(s) 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 breaches we found at our inspection on 5 July 2018.

Background

Queensway Dental Practice is located in Bletchley, a town in Milton Keynes and provides predominantly NHS treatment to adults and children. The practice also offers some private treatments for adults and children.

Access to the practice is only accessible by climbing a staircase to the first floor of the premises. The premises were therefore not suitable for those who use wheelchairs and those with pushchairs.

Car parking spaces, including some allocated for blue badge holders, are available near the practice in public car parks.

The dental team includes four dentists, one dental hygiene therapist, six dental nurses (including two trainees and two nurses who were due to start working at the practice), two receptionists and a practice manager.

The practice has four treatment rooms. A new treatment room was being installed at the time of our visit. The provider had recently renovated the reception area to create more space for staff and patients. They had also installed a new phone system to make it easier for patients to get through to the practice when they called.

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 practice were accepting new NHS patients at the time of our inspection.

During the inspection we spoke with three dentists, three dental nurses, one 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 from 9am to 5.30pm, Tuesday from 9am to 7.30pm, Wednesday, Thursday and Friday from 9am to 5.30pm and Saturday from 9am to 2pm.

Our key findings were:

• Systems and processes for incident reporting and investigating had improved. Discussion took place amongst staff, where applicable to prevent risk from recurring.

• Risks presented by legionella had been addressed.

• The sharps risk assessment required review. Not all dentists used the safest type of sharps or had access to a safe re-sheathing device.

• The provider had implemented a structured approach to implementing policy and its review.

• Staff files contained the required information as specified in legislative requirements.

• Staff continuing professional development information was held as well as indemnity information, where applicable.

• The practice were following guidance from the Department of Health in the Health Technical Memorandum 01-05: Decontamination in primary care dental practices.

• The dentists were following guidelines issued by the Faculty of General Dental Practice.

• The practice had not obtained a hearing loop for any patients who may benefit.

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

• 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 responsibilities to take into account the needs of patients with disabilities and to comply with the requirements of the Equality Act 2010.

We carried out this short notice announced inspection on 05 July 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

Queensway Dental Practice is located in Bletchley, a town in Milton Keynes and provides predominantly NHS treatment to adults and children. The practice also offers some private treatments for adults and children.

Access to the practice is only available by climbing a staircase to the first floor of the premises. The premises were therefore not suitable for those who use wheelchairs and those with pushchairs.

Car parking spaces, including some allocated for blue badge holders, are available near the practice in public car parks.

The dental team includes five dentists, an implantologist and oral surgeon, three dental nurses, two trainee dental nurses, two dental hygienists and a receptionist. A newly appointed practice manager was due to start working at the practice and attended on the day of our inspection.

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.

On the day of inspection we collected 16 CQC comment cards filled in by patients.

During the inspection we spoke with three dentists, three dental nurses and the newly appointed practice manager. We looked at practice policies and procedures, patient feedback and other records about how the service is managed.

The practice is open: Monday, Wednesday, Thursday and Friday from 8.30am to 5pm, Tuesday from 8.30am to 7pm and Saturday from 9am to 2pm.

Our key findings were:

• The practice appeared clean on the day of our visit although there had been no formal process to monitor the standard of cleaning.
• The provider had infection control procedures which mostly reflected published guidance, although we noted areas for practice review and improvement.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available with the exception of clear face masks which were obtained after the inspection.
• The practice had some systems to help them manage risk to patients and staff. We found areas that required significant improvement.
• Safeguarding arrangements required review to ensure all staff maintained up to date training and effective monitoring was in place.
• The provider had incomplete staff recruitment procedures at the point of recruitment; this included the checks made on agency staff who had worked in the practice.
• The clinical staff provided patients’ care and treatment in line with current guidelines.
• On the day of our inspection, we saw that staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• We noted evidence to support that the practice was providing preventive care and helping patients maintain better oral health.
• The appointment system met patients’ needs.
• Staff we spoke with told us they worked well with their fellow colleagues.
• The practice asked patients for feedback about the services they provided.
• The provider dealt with complaints received in a timely manner. We were not provided with evidence to show that staff learning from complaints took place.
• We found leadership and governance arrangements required significant strengthening.

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.
• Ensure recruitment procedures are established and 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. They should:

• Review the practice’s infection control procedures and protocols taking into account the guidelines issued by the Department of Health in the Health Technical Memorandum 01-05: Decontamination in primary care dental practices. In particular, staff wearing of jewellery and nail varnish.
• Review the need to effectively record caries, periodontal and cancer risks within patients’ dental care records, taking into account the guidance provided by the Faculty of General Dental Practice.
• Review the practice's responsibilities to take into account the needs of patients with disabilities and to comply with the requirements of the Equality Act 2010.
• Review the practice's policies and procedures for obtaining patient consent to care and treatment to ensure they are in compliance with legislation, take into account relevant guidance, and staff follow them.

We spoke with three people who used the service and they all provided positive feedback. One person told us that they were particularly nervous of visiting the dentist however since they had used the Queensway Dental Practice they had been put at ease and felt more relaxed. People told us that they dental staff were very good at explaining what they had found and if treatment was required this was explained to each person, with different treatment options discussed.

We found that appropriate arrangements were in place to obtain consent, and people's needs were assessed and treatment plans were produced to meet those needs. We found that the cleaning and infection control arrangements were in accordance with guidance issued by the Department of Health and checks were carried out on staff before they commenced employment. We found that the provider had arrangements in place to deal with complaints that were received.