We undertook a follow up focused inspection of Revive Dental Care - Manchester city centre on 3 December 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 led by a CQC inspector who was supported by a specialist dental adviser.

We undertook a comprehensive inspection of Revive Dental Care - Manchester city centre on 17 September 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 12 and 17 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 Revive Dental Care - Manchester city centre 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. We then inspect again after a reasonable interval, focusing on the areas 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 17 September 2018.

Background

Revive Dental Care - Manchester city centre is in Salford and provides NHS and private treatment to adults and children.

Due to the nature of the premises wheelchair access is not possible. Car parking spaces are available near the practice.

The dental team includes three dentists, three dental nurses (two of whom are trainees), one receptionist and a practice manager. The practice has three treatment rooms.

The practice is owned by a 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. The registered manager at Revive Dental Care - Manchester city centre had recently left the organisation and the practice manager was in the process of applying to be the registered manager.

During the inspection we spoke with one dentist, one dental nurse 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 to Friday from 9am to 5pm

Our key findings were:

• A Legionella risk assessment had been completed and most actions addressed.
• Disclosure and Barring Service (DBS) checks had been obtained and evidence of Hepatitis B titre levels were also available for all members of staff.
• Recommendations from the routine testing of the X-ray machines had been actioned.
• The medical emergency drugs and equipment reflected nationally recognised guidance.
• A practitioner specific X-ray audit had been carried out.
• Records relating to patient complaints were now stored in a separate folder.

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

• Review the Legionella risk assessment and ensure cold water temperatures are tested and recorded from the sentinel outlets.

We carried out this announced inspection on 17 September 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

Revive Dental Care - Manchester city centre is in Salford and provides NHS and private treatment to adults and children.

Due to the nature of the premises wheelchair access is not possible. Car parking spaces are available near the practice.

The dental team includes three dentists, three dental nurses (two of whom are trainees), one receptionist and a practice manager. The practice has three treatment rooms.

The practice is owned by a 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. The registered manager at Revive Dental Care - Manchester city centre had recently left the organisation and the practice manager was in the process of applying to be the registered manager.

On the day of inspection, we collected 24 CQC comment cards filled in by patients.

During the inspection we spoke with two dentists, one dental nurse, 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 to Friday from 9:00am to 5:00pm

Our key findings were:

• The practice appeared clean and well maintained.
• The provider had infection control procedures which reflected published guidance.
• Staff knew how to deal with emergencies. Not all equipment to deal with medical emergencies was available.
• The practice had some systems to help them manage risk to patients and staff. A Legionella risk assessment had not been completed and recommendations from maintenance reports of X-ray equipment had not been acted on.
• The practice had safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children. Not all staff had completed safeguarding training.
• Staff were qualified for their roles. The recruitment process could be improved.
• 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 provider was providing preventive care and supporting patients to ensure better oral health.
• The appointment system met patients’ needs.
• The practice asked patients for feedback about the services they provided.
• The provider dealt with complaints positively and efficiently. Storage of documents relating to patient complaints could be improved.

We identified regulations the provider was not complying with. They must:

• Ensure care and treatment is provided in a safe way to patients
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care

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

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

• Review staff training to ensure that all the staff have received training, to an appropriate level, in the safeguarding of children and vulnerable adults.
• Review the security of NHS prescription pads in the practice and ensure there are systems in place to track and monitor their use.