We carried out a focused inspection of Regency Dental Practice on 18 January 2018.

The inspection was led by a CQC inspector who was supported by a specialist dental adviser. We carried out the inspection to follow up concerns we originally identified during a comprehensive inspection at this practice on 5 June2017 and had not been resolved when we visited on 9 September 2018 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions.

At a comprehensive inspection we always ask the following five questions to get to the heart of patients’ experiences of care and treatment:

• Is it safe?
• Is it effective?
• Is it caring?
• Is it responsive to people’s needs?
• Is it well-led?

When one or more of the five questions is 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.

At the previous comprehensive and focused inspections we found the registered provider was providing safe, effective, caring and responsive care in accordance with relevant regulations. We judged the practice was not providing well-led care in accordance with Regulations17 and 18 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 Regency Dental Practice on our website www.cqc.org.uk.

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 to put right the shortfalls and deal with the regulatory breaches we found at our inspections on 5 June and 9 September 2017.

We carried out a focused inspection of Regency Dental Practice on 4 September 2017.

The inspection was led by a CQC inspector who was supported by a specialist dental adviser. We carried out the inspection to follow up concerns we originally identified during a comprehensive inspection at this practice on 5 June2017 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions.

At a comprehensive inspection we always ask the following five questions to get to the heart of patients’ experiences of care and treatment:

• Is it safe?
• Is it effective?
• Is it caring?
• Is it responsive to people’s needs?
• Is it well-led?

When one or more of the five questions is 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.

At the previous comprehensive inspection we found the registered provider was providing safe, effective, caring and responsive care in accordance with relevant regulations.

We judged the practice was not providing well-led care in accordance with Regulations17 and 18 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 Regency Dental Practice on our website www.cqc.org.uk.

Our findings were:

Are services well-led?

We found this practice was not providing well-led care in accordance with the relevant regulations. We have told the provider to take action (see full details of this action in the Requirement Notices and Enforcement sections at the end of this report).

The provider had made insufficient improvements to put right the shortfalls and had not dealt with the regulatory breaches we found at our inspection on 4 June 2017.

We carried out this announced inspection on 5 June 2017 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 specialist dental advisor.

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 this practice was 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 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

Regency Dental Practice is a listed town house in Melksham with four surgeries over three floors. The exterior of the building is in disrepair with flaking paint work and rotting window frames. The main entrance is closed and access is up a small driveway to the back of the property. There is flat access to the reception area and a downstairs surgery. The practice had toilet on the ground floor but it was not wheelchair accessible. The practice offers predominantly NHS treatment to patients of all ages.

Car parking spaces are available near the practice. The practice is well located near a main bus route.

The dental team includes two dentists one of whom is currently taking maternity leave and a locum dentist, a dental hygienist, four dental nurses, one trainee dental nurse, a decontamination assistant and three receptionists. The team is supported by a practice manager. The practice had four treatment rooms.

The practice is a Limited Company 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. There is currently no registered manager at practice as the practice manger is newly appointed. They told us they would be applying to be registered soon.

On the day of inspection we collected 19 CQC comment cards filled in by patients and spoke with four other patients. This information gave us a positive view of the practice.

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

The practice is open Monday - Thursday 08.30am -4.30pm and Friday 08.30am - 4.00pm. The practice is closed at weekends. Contact information is available from the practice telephone answering service. The out of hours emergency arrangements were displayed on the website.

Our key findings were:

• The practice was clean and well maintained.
• The practice had infection control procedures in place which reflected published guidance.
• The practice had safeguarding processes in place and staff knew their responsibilities for safeguarding adults and children.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• The practice had limited systems to help them manage risk.
• 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 appointment system met patients’ needs and dedicated emergency appointments were available.
• The practice used digital radiographs to help explain necessary treatment to patients.
• The practice leadership was limited and lacked effective systems to ensure the safety and quality of the delivery of regulated activities.
• Most staff felt involved and supported by the practice management.
• The practice recruitment procedures did not meet the legislative requirements for the safe recruitment of staff.
• The practice asked patients for feedback about the services they provided through the Friends and Family test only.
• The practice dealt with complaints positively and efficiently.

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

• Ensure the training, learning and development needs of individual staff members are monitored and maintained at appropriate intervals.
• Ensure an effective process is established for the on-going assessment, supervision and appraisal of all staff.
• Ensure that there are systems in place for assessing, monitoring and mitigating all risks. Ensure risk assessments are adapted to reflect the risks in the practice and how they would be mitigated.
• Ensure that electrical hard wiring and gas safety certificates are obtained.

We spoke with four people who used the services at The Regency Dental Practice who were positive about the service they received.

One person we spoke with said they received a good service. They told us the dentist explained their treatments and they were happy to agree to these. They were particularly pleased that they had treatment recently with no anaesthetic, were happy that the dentist used ‘white’ fillings because they were not noticeable and said they would recommend the practice.

Others said “the practice is friendly and accommodating” and the “dentist is polite and makes me feel comfortable”. One person said “my dentist understands”, when talking about their nervousness. Another patient told us they had difficulty managing stairs so arrangements were made for them to use the ground floor treatment room.

We saw that one person who completed a practice survey questionnaire added “all of the staff were very kind to my mother who was 92 and had dementia” and “very pleased with every aspect of this practice”. Another person who commented on the friendliness of the practice did comment that they felt the building “looks tired”.

The NHS Choices website encourages people to add comments about their experiences to share with others. We noted that one person had written anonymously about The Regency Dental Practice. They indicated they were very satisfied with the outcome of their treatment, the information about it’s cost, involvement in decisions and being treated with dignity and respect. They also wrote they felt it to be an “absolutely fabulous service through and through”. They felt that appointment waiting times could be improved but acknowledged that delays sometimes happen due to unforeseeable events during other people’s treatments.