We carried out this inspection to follow up concerns we originally identified during a comprehensive inspection at the practice on 14 November 2017 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 area 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 Regulation 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 Royston Dental Suite on our website www.cqc.org.uk.

During this inspection we spoke with the principal dentist and a dental nurse. We checked the decontamination and treatment rooms, and viewed a range of paperwork in relation to the management of the practice.

Our findings were:

• The provider had made adequate improvement to put right the shortfalls we found at our previous inspection. The provider should ensure that the newly implemented improvements are embedded and sustained in the long- term in the practice.

We carried out this announced inspection on 14 November 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. We also wanted to check that the provider had taken action to address the shortfalls we found during our previous inspection of 21 October 2015. A CQC inspector, who was supported by a specialist dental adviser, led the inspection.

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

Royston Dental Suite provides mostly private dental treatment to patients of all ages. The practice is located on the first floor, above shops in Royston High Street and is accessed by a staircase. It has one treatment room, a staff kitchen area, reception, waiting room and a decontamination area. The practice is open Monday to Friday 9am to 5.30pm. For private patients, the practice has extended opening hours on Monday and Thursday evenings until 7.30pm. The staff team consist of a principal dentist, a dental nurse and a receptionist. Locum dentists and nurses are regularly used to cover vacant shifts.

The practice is owned by an individual who is the principal dentist, Dr Shikha Mittal. She has 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 the principal dentist, a dental nurse and the receptionist. We looked at the practice’s policies and procedures, and other records about how the service was managed. We collected eight comment cards filled in by patients prior to our inspection and spoke with another patient on the day.

Our key findings were:

• The practice had suitable safeguarding processes and staff knew their responsibilities for protecting vulnerable adults and children.

• The appointment system met patients’ needs and patients were able to sign up to text reminders.

• The practice was clean, well maintained, and had infection control procedures that mostly reflected published guidance.

• Staff knew how to deal with medical emergencies and there was suitable equipment available for them.

• Patients’ needs were assessed and care was planned and delivered in line with current best practice guidance from the National Institute for Health and Care Excellence (NICE) and other published guidance.

• There was no system in place to ensure that untoward events were analysed and used as a tool to prevent their reoccurrence.

• Systems to ensure the safe recruitment of staff were not robust, as essential pre-employment checks had not been completed.

• The practice had failed to address a number of shortfalls we had identified at our previous inspection in 2015 in relation to dental care records, employment practices, the provision of a hearing loop and incident reporting.

We identified regulations that were not being met and the provider must:

• Ensure the practice's recruitment policy and procedures are suitable and the recruitment arrangements are in line with Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 to ensure necessary employment checks are in place for all staff.

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

• Review the practice’s system for the 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 responsibilities to the needs of people with a disability and the requirements of the Equality Act 2010.

We carried out an announced comprehensive inspection on 21 October 2015 to ask the practice the following key questions; Are services safe, effective, caring, responsive, and well-led?

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

We carried out a comprehensive inspection of Royston Dental Suite on 21 October 2015. Royston Dental Suite is a single handed practice and provides both NHS and private dental treatment to patients of all ages. The lead dentist employs a dental nurse and a regular locum dental nurse, provided by an agency is used.

The practice is located on the first floor, above shops in the High Street and access is by a staircase. It has one treatment room, a staff kitchen area, reception, waiting room and one decontamination room for cleaning, sterilising, and packing dental instruments. The practice is open Monday to Friday 9am to 5.30pm. For private patients, the practice has extended opening hours on Monday and Thursday evenings to 7.30pm. The contract held for NHS patients does not include extended hours.

We spoke with three patients during our inspection and received six comments cards that had been completed by patients prior to our inspection. We received positive comments about the cleanliness of the premises, the empathy, and responsiveness of staff and the quality of treatment provided.

Three people told us that staff explained treatment plans to them well. Patients reported that the practice had seen them on the same day for emergency treatment. Patients commented that the service they received was good, and that they were always clear about the costs involved in their treatment.

Our key findings were:

• The practice had sufficient policies in place, however, the management systems needed to give oversight to ensure that they were being followed needed to be strengthened.

• There were sufficient numbers of staff to meet patients’ needs.

• The practice actively sought feedback from patients through questionnaires and used it to improve the service provided.
• The practice offered extended hours and out of hours emergency care for patients.
• We found that systems, risk assessments, and regular audits were not in place to give oversight and ensure compliance with regulations, safety including management of materials and medicines, and performance to identify risks, mitigate, and drive improvements.
• We found that dental care records were not well maintained and did not contain the relevant information needed to reflect patients’ consent, and decisions in relation to their treatment.

We identified regulations that were not being met and the provider must:

• Ensure the practice policy for staff recruitment is followed and temporary staff receive induction and explaniation to practice’s processes.

• Ensure that dental care records are written, maintained and contain the relevant information needed to reflect patients’ consent, and decisions in relation to their treatment.
• Ensure that systems, risk assessments, and regular audits are in place to ensure compliance with regulations, safety including management of materials and medicines, and performance to identify risks, mitigate and drive improvements.

You can see full details of the regulations not being met at the end of this report.

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

• Have regard to NHS England’s publication for Delivering Better Oral Health- an evidence based toolkit to support dental practices in improving their patients’ oral and general health, National institute of Clinical Excellence (NICE) guidelines, and Faculty of General Dental Practice record keeping/selection criteria for X-rays.
• Record verbal feedback to identify areas where improvements could be made.
• Obtain evidence that locum staff, provided through an agency hold up to date training records.