We undertook a focused inspection of Robinson & Dicker Dental Practice on 14 August 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 dentally qualified. A member of the CQC’s administrative team also attended the inspection.

We undertook a comprehensive inspection of Robinson & Dicker Dental Practice on 30 January 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 in accordance with the relevant regulations 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 Robinson & Dicker dental practice on our website www.cqc.org.uk.

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.

As part of this inspection we asked:

Is it well-led?

Our findings were:

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 breach we found at our inspection on 30 January 2018.

Background

Robinson & Dicker Dental Practice is in Birmingham and provides NHS and private treatment to adults and children.

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

The dental team includes four dentists, five dental nurses, one dental hygiene therapist, three receptionists and a practice manager. The practice has five 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.

During the inspection we spoke with one dentist, 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 from Monday to Friday between 8.30am and 5.30pm and opens until 7pm on Thursdays.

Our key findings were:

• The practice had implemented effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

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

• Review the practice's protocols for monitoring and recording the fridge temperature to ensure that medicines and dental care products are being stored in line with the manufacturer’s guidance.
• Review the practice’s system for recording, investigating and reviewing incidents or significant events with a view to preventing further occurrences and ensuring that improvements are made as a result.
• Review the practice's protocols and procedures to ensure staff are up to date with their mandatory training and their continuing professional development.
• Review the practice’s audits to ensure that, where appropriate, audits have documented learning points and the resulting improvements can be demonstrated. They should also ensure that the radiography audits cover the different types of radiographs taken by staff.

We carried out this announced inspection on 30 January 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. A member of CQC administrative staff also attended the inspection.

We told the NHS England area team that we were inspecting the practice. They did not provide any information for us to take into account.

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

Robinson & Dicker Dental Practice is located in Birmingham providing NHS and private dental treatment to patients of all ages.

There is level access for people who use wheelchairs and pushchairs. Car parking spaces, including those for patients with blue badges, are available immediately outside the practice.

The dental team includes four dentists, four dental nurses (two of whom are trainees), one dental hygienist therapist, two receptionists and a practice administrator. The principal dentist had also recruited an independent practice advisor who visited the practice on an ad hoc basis to assist with its management. The practice has five 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 45 CQC comment cards filled in by patients and spoke with three other patients. This information gave us a positive view of the practice.

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

The practice is open from Monday to Friday between 8:30am and 5:30pm and opens until 7pm on Thursdays.

Our key findings were:

• The practice was clean and well 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 but we identified some necessary improvements.
• The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• The practice had limited staff recruitment procedures. The recruitment policy was not comprehensive and some essential documentation was not available in the staff recruitment files.
• 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 but several patients commented that waiting times were an issue. Staff had made changes before our visit and the situation had improved.
• Staff felt involved and supported and worked well as a team. The provider was in the process of recruiting a practice manager to assist with leadership at the practice.
• The practice asked staff and patients for feedback about the services they provided.
• The practice dealt with complaints positively and efficiently.
• Audits in key areas (infection control, X-rays and dental record keeping) were overdue and/or incomplete.

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