We carried out this inspection to follow up concerns we originally identified during a comprehensive inspection at the practice on 7 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 and Regulation 19 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 Saxon Dental Practice on our website www.cqc.org.uk.

During this inspection we spoke with the practice manager. We checked the decontamination room 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 most of the shortfalls we found at our previous inspection. The provider must ensure that all newly implemented improvements are embedded and sustained in the long- term in the practice.

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

• Review protocols for the use of rubber dam for root canal treatment giving due regard to guidelines issued by the British Endodontic Society.

• Review their responsibilities to meet the needs of patients with disability and the requirements of the Equality Act 2010.

• Review systems for appraising staff and implementing personal development plans.

We carried out this announced inspection on 7 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. 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

Saxon Dental Practice provides mostly NHS dentistry to patients of all ages. The dental team consists of five dentists, two hygienists, seven dental nurses and two receptionists. The practice has three treatment rooms and is open Mondays, Wednesdays, Thursdays and Fridays from 8.30am to 5pm; and on Tuesdays from 8.30am to 7pm. The practice also opens one Saturday a month from 8.30am to 12.30pm

There is level access for wheelchair and pushchair users at the side of the building.

The practice is owned by an individual who is one of the principal dentists, Dr Karl Anders Birger Fagher. 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.

During the inspection, we spoke with the two principal dentists and an associate dentist. We also spoke with two dental nurses. We looked at the practice’s policies and procedures, and other records about how the service was managed. We collected 28 comment cards filled in by patients prior to our inspection and spoke with another two patients on the day.

Our key findings were:

• We received many very positive comments from patients about the dental care they received and the staff who delivered it.

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

• The appointment system met patients’ needs and patients were able to sign up to text reminders. The practice offered evening and Saturday morning appointments.

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

• Staff knew how to deal with medical emergencies, although not all equipment recommended by the British National Formulary, the Resuscitation Council (UK), and the General Dental Council (GDC) standards was available.

• 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.

• The practice’s sharps handling procedures and protocols did not comply with the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.

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

• Risk assessment was limited and recommendations to improve safety for patients and staff were not always implemented.

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

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care. This includes the recording and monitoring significant events; ensuring appropriate medical emergency equipment is available, implementing risk control measures, monitoring water temperatures, ensuring staff receive regular appraisal of their performance and have an understanding of the requirements of the Mental Capacity Act (MCA) 2005.

• 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 protocols for the use of rubber dam for root canal treatment giving due regard to guidelines issued by the British Endodontic Society.