We carried out an announced comprehensive inspection of this service on 27 May 2015 as part of our regulatory function where a breach of legal requirements was found. After the comprehensive inspection, the practice wrote to us to say what they would do to meet the legal requirements in relation to the breach.

We followed up on our inspection of 27 May 2015 to check that the practice had implemented their plan and to confirm that they now met the legal requirements. We carried out a desk based review on 28 July 2016 to check whether the practice had taken action to address a breach of Regulation 17(1) and (2) (a) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

This report only covers our findings in relation to those requirements. We have not revisited Scott Arms Dental Practice for this review because the registered provider was able to demonstrate that they were meeting the standards without the need for a visit. You can read the report from our previous comprehensive inspection by selecting the ‘all reports’ link for Scott Arms Dental Practice on our website at www.cqc.org.uk.

Our findings were:

Are services well-led?

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

Key findings

• Overall we found that sufficient action had been taken to address the shortfalls identified at our previous inspection and the provider was now compliant with the regulation.

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

• Review its own recruitment policy to establish whether the practice is in compliance when recruiting new staff members with regards to DBS checks and references.
• Review the training, learning and development needs of individual staff members and have an effective process established for the on-going assessment and supervision of all staff. This includes regular appraisals for all staff and ensuring they are up-to-date with core CPD topics such as safeguarding children.
• Review training records and adopt an effective process to highlight any staff members who have not completed mandatory training and ensure they do so within the recommended timeframe.

We carried out an announced comprehensive inspection on 27 May 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.

There were 12 surgeries with 31 dentists working at the practice. Some of the dentists specialised in orthodontics (treatment of irregular teeth). The practice also has self employed therapists and there was a team of dental nursing staff who also undertook dental nursing duties. There was also a practice manager and a deputy practice manager. The practice offered both private and NHS treatment. The provider told us that 80% of treatment provided was private and they saw approximately 6000 patients a month. The patient population was diverse and the provider told us that many patients came from out of the locality.

The provider is the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the practice is run.

We viewed 13 CQC comment cards that had been left for patients to complete, prior to our visit, about the services provided. All of the comment cards reflected positive comments about the staff and the services provided. Patients commented that the staff were friendly and helpful and made them feel at ease. We spoke with seven patients during our inspection visit and all the patients said they found the staff were very friendly and approachable and they found the quality of the dentistry to be excellent. They said explanations were clear and with alternative options for treatment made clear to them.

Our key findings were:

• The practice had a system in place to record significant events, safety issues and complaints and to cascade learning to staff.
• Most staff had received safeguarding training and knew the processes to follow to raise any concerns.
• There were sufficient numbers of staff to meet the needs of patients requiring general dental treatment. However, there was only one dental nurse trained to support with treatment requiring sedation.
• Staff had been trained to handle emergencies and appropriate medicines were readily available.
• Infection control procedures were robust and staff were able to demonstrate how they followed the published guidance.
• Patients received clear explanations about their proposed treatment, costs, benefits and risks and were involved in decisions about it.
• Patients were treated with dignity and respect and information about them was handled confidentially.
• The appointment system met the needs of patients and waiting times were kept to a minimum.
• There was an effective complaints system and the practice was open and transparent with patients if a mistake had been made.
• There was a range of clinical and non-clinical audits to monitor the quality of services. However, we were not provided with a recent audit on the quality of X-rays on the day.
• The practice sought feedback from patients about the services they provided.

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

• Ensure robust governance structures are in place to ensure quality and safety of the service.

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:

• Document actions discussed following an incident where appropriate.
• All staff should attend formal safeguarding training.
• Checks on the Automated External Defibrilator (AED) should be documented.
• Take due regard to the new guidelines in conscious sedation published by the Intercollegiate Advisory Committee.
• Consider arrangements to provide a translation service when required.

We gave the provider three days notice that we were going to visit the service. During our visit we spoke with the provider, practice manager and two staff. We looked at the records for twelve people who had used the service. It was not appropriate to speak to people at the practice on the day we visited. Following our visit, we spoke to eight people over the telephone who had recently used the service so that we could gain people’s views of the service provided.

All of the people we spoke with were very complimentary about the service. Comments made to us included, “It is very well run, I am impressed with the treatment” and “I am very satisfied”. Treatment options were explained to people and they had time to consider their options. This meant a full discussion took place and people were given the information they needed to be able to make an informed decision about their treatment.

All of the people we spoke with told us the practice was “spotless” and that staff wore protective equipment when treatments were being carried out. During our visit we saw that all areas of the practice were clean. The provider had effective infection control procedures in place. This meant the risk of infection for people using the service was minimised.

Staff received a range of training so that they had up to date knowledge and skills in

order to support the people who attend the practice. All of the people we spoke with told us that the staff were very friendly and welcoming and that they knew people by name. Direct comments included. “Always feel relaxed staff and the dentist are very reassuring’’. “They don’t judge you, I have always been so scared of the dentist, all I can say is they have changed my life I now have the teeth I have always wanted’’.

“If you want a good dentist then Scott Arms is the place to go, wonderful service would highly recommend’’

There were systems in place to monitor how the practice was run to ensure people received a quality service.