We carried out a focused inspection of Salisbury Dental Centre on 6 March 2018.

We carried out the inspection to follow up concerns we originally identified during a comprehensive inspection at this practice on 16 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 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 regulation17 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 Salisbury Dental Centre 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 breach we found at our inspection on 16 November 2017.

We carried out a focused inspection of Salisbury Dental Centre on 6 March 2018.

We carried out the inspection to follow up concerns we originally identified during a comprehensive inspection at this practice on 16 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 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 regulation17 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 Salisbury Dental Centre on our website www.cqc.org.uk.

We carried out this announced inspection on 16 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. The inspection was led by a CQC inspector who was supported by a specialist dental adviser.

We told the NHS England area team and Healthwatch that we were inspecting the practice. They did not provide any information.

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

Salisbury Dental Centre is close to the centre of the city and provides NHS and private treatment to patients of all ages. There are good transport links to the practice.

There is level access for patients who use wheelchairs and pushchairs. Car parking spaces can be found on roads near the practice or in the nearby public car parks.

The dental team includes four dentists, six dental nurses, one dental hygienist, two receptionists and a practice manager. The practice has five 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 Salisbury Dental Centre was the practice manager.

On the day of inspection we collected 14 CQC comment cards filled in by patients and spoke with two other patients. This information gave us a positive view of the practice.

During the inspection we spoke with four dentists, three dental nurses, a 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 Thursday 8.30am – 1pm & 2pm - 5.30pm
• Friday 8.30am - 1pm
• Out of hours information displayed on website and via telephone answering service.

Our key findings were:

• The practice appeared 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 some systems to help them manage risk but they were not always operated effectively.
• The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• The practice recruitment procedures did not meet the legislative requirements for the safe recruitment of staff.
• 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.
• The practice had mostly effective leadership but it did not ensure staff completed all required continuing professional development through appraisal.
• Staff felt involved and supported and worked well as a team.
• The practice asked staff and patients for feedback about the services they provided but this was not analysed or results shared with staff and patients.
• The practice dealt with complaints positively and efficiently.

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.

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

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

• Review its policy and procedures in reporting relevant incidents to the Care Quality Commission, when appropriate.

On the day following our visit we were able to speak with three people who had attended the practice for a number of years. They said they were pleased with the service provided and had never had reason to raise a concern or make a complaint. One person described the practice as “very good.”

People told us they were involved in all decisions relating to their treatment. They said they were asked whether there had been medical changes the dentist would need to be aware of. There was information available regarding the cost of treatments in the waiting area.

People said they could make appointments easily and they were greeted by “pleasant and helpful” reception staff.

The practice had policies and procedures to ensure children and vulnerable adults were protected. Some staff had not completed training in safeguarding vulnerable people.

The dental nurses explained how infection control was managed within the practice. They told us they had received infection control training as part of their qualification course work and attended on-going training. We saw certificates which confirmed their attendance.

We were able to talk with three of the dentists and three dental nurses. They told us they felt supported and enjoyed working at the practice.