We undertook a focused inspection of Rose Cottage Dental Practice on 19 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 advisor.

We had undertaken a comprehensive inspection on 11 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 effective or 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 Rose Cottage 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 effective
• Is it well-led

Background

Rose Cottage Dental Practice is based in North Walsham and offers private treatment to approximately 800 patients. The dental team consists of one dentist, one dental nurse, and a receptionist. There is one treatment room. The practice opens on Mondays, Tuesdays, Thursdays and Fridays from 8.30am to 5.30pm. There is level access for wheelchair users but there is not any parking for blue badge holders near to the practice.

The practice is owned by an individual who is the principal dentist there. He has legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run.

Our findings were:

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

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

The provider had made sufficient improvements in relation to the regulatory breaches we found at our previous inspection. These must now be embedded and sustained in the long-term.

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

• Review the practice's protocols for completion of dental care records taking into account guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.

We undertook a focused inspection of Rose Cottage Dental Practice on 2 November 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.

We had undertaken a comprehensive inspection 11 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 safe 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 Rose Cottage 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 safe?

Background

Rose Cottage Dental Practice is based in North Walsham and offers private treatment to approximately 800 patients. The dental team consists of one dentist, one dental nurse, and a receptionist. There is one treatment room. The practice opens on Mondays, Tuesdays, Thursdays and Fridays from 8.30am to 5.30pm. There is level access for wheelchair users but there is not any parking for blue badge holders near to the practice.

The practice is owned by an individual who is the dentist there. He has legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run.

Our findings were:

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

The provider had made improvements in relation to the regulatory breach we found at our previous inspection.

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

• Review autoclave testing protocols and ensure weekly and quarterly testing is completed in line with guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices.

We carried out this announced inspection on 11 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 this practice was not providing safe care in accordance with the relevant regulations.

Are services effective?

We found this practice was not 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

Rose Cottage Dental Practice is based in North Walsham and offers private treatment to approximately 800 patients. The dental team is small and consists of one dentist, one dental nurse, and a receptionist. There is one treatment room. The practice opens on Mondays, Tuesdays, Thursdays and Fridays from 8.30am to 5.30pm. There is level access for wheelchair users but no disabled parking nearby.

The practice is owned by an individual who is the dentist there. He has 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 37 CQC comment cards filled in by patients and spoke with another two.

During the inspection we spoke with the dentist, a locum nurse and the receptionist. We looked at practice policies and procedures and other records about how the service is managed.

Our key findings were:

• Staff treated patients with dignity and respect, and we received many positive comments from patients about the caring and empathetic nature of the dentist.

• The practice was small and friendly, something which both patients and staff appreciated.

• The appointment system met patients’ needs and a text appointment reminder service was available.

• Staff felt supported and worked well as a team. The dentist asked staff and patients for feedback about the services they provided and implemented their suggestions.

• Staff recruitment procedures were not followed and employment records did not demonstrate that staff were suitable to work with vulnerable patients.

• Patient dental care records did not reflect standards set by the Faculty of General Dental Practice regarding clinical examinations and record keeping.

• The management of risk in the practice was limited and potential hazards had not been assessed adequately.

• Medicines were not managed or prescribed according to national guidance.

• The practice’s infection control procedures did not comply with national guidance.

• The practice did not have a structured plan in place to audit the quality and safety of its service.

We identified regulations the provider was not meeting. They must:

• Ensure care and treatment is provided in a safe way to patients.
• Ensure the care and treatment of patients is appropriate, meets their needs and reflects their preferences.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

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

• 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 spoke with three patients who were waiting for treatment or had just received treatment from the dentist. They were very complimentary on the service they received.

Two people told us that The practice was recommended to them when they moved to the area and they had no cause for complaint People told us that the dentist was very friendly and that treatment options were also discussed with them prior to their treatment commencing. One person told us, "It might be a very small practice but the staff are very professional."