We undertook a focused follow up inspection of Sefton Dental Centre on 24 January 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 carried out by a CQC inspector.

We undertook a comprehensive inspection of Sefton Dental Centre on 26 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 well-led care and was in breach of 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 Sefton Dental Centre on our website www.cqc.org.uk.

As part of this inspection we asked if care and treatment was:

• well-led?

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 area where improvement was required.

Are services well-led?

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

The provider had made improvements in relation to the regulatory breaches we found at our inspection on 26 September 2018.

Background

Sefton Dental Centre is in Bootle, Merseyside and provides NHS treatment for adults and children. Some private treatment is also available.

There is level access for people who use wheelchairs and those with pushchairs. There is no dedicated car parking for the practice. There is access to a space for disabled drivers which can sometimes be arranged for patients that require this.

The dental team includes three dentists, five dental nurses, one of whom is a trainee, two dental hygiene therapists and two receptionists. A practice manager and a human resources (HR) manager work between this practice and a sister site. The practice has four treatment rooms.

The practice is owned by an organisation 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 Sefton Dental Centre is the principal dentist and owner of the organisation.

During the inspection we spoke with the practice manager and HR manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open Monday to Thursday, from 7.45am to 8pm, and on Friday from 7.45am to 5.30pm.

Our key findings were:

The provider had made improvements to governance systems across the practice, in accordance with the fundamental standards of care. This included:

• Records held in respect of recruitment were now more complete, including information on staff immunity to Hepatitis B. Where evidence of immunity was not available, for example, in cases of trainees who had not completed the Hepatitis B vaccination course, risk assessments were in place to minimise the likelihood of injury from sharps.

• Disclosure and Barring Service (DBS) checks were in place for all staff working at the practice. We saw that recruitment files also held all documents as required by Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) 2008, including proof of address and career history.

• All staff were now receiving performance reviews. Newer staff at the practice were receiving regular one-to-one meetings to review their induction training and on-going learning needs.

• Systems for reporting, analysing and sharing any lessons learned from significant events were in place.

Further improvements had been made by the provider in relation to:

• Management of radiation and radiation equipment.

• Staff training related to safety at work.

• Infection control

• Audit and continuous improvement

• Prescription pad security

• Engagement of staff through feedback surveys.

We carried out this announced inspection on 26 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 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

Sefton Dental Centre is in Bootle, Merseyside and provides NHS treatment to adults and children. Private treatment is also available.

There is level access for people who use wheelchairs and those with pushchairs. There is no dedicated car parking for the practice. There is access to a space for disabled drivers which can sometimes be arranged for patients that require this.

The dental team includes three dentists, five dental nurses, one of whom is a trainee, two dental hygiene therapists and two receptionists. There is a practice manager and a human resources (HR) manager that work between this practice and a sister site. The practice has four treatment rooms.

The practice is owned by an organisation 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 Sefton Dental Centre is the principal dentist and owner of the organisation.

On the day of inspection, we collected 23 CQC comment cards filled in by patients.

During the inspection we spoke with two dentists, one dental nurses, the practice manager and HR manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open Monday to Thursday, from 7.45am to 8pm, and on Friday from 7.45am to 5.30pm.

Our key findings were:

• The practice appeared clean and well ordered.
• The provider 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 systems to help them manage risk to patients and staff. This required improved management, governance and oversight.
• The practice staff had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
• The provider had staff recruitment policies in place. Our inspection of recruitment records showed that policies were not always followed. Recruitment records were incomplete.
• 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 provider was providing preventive care and supporting patients to ensure better oral health.
• The appointment system met patients’ needs.
• The practice had leadership that was supportive.
• Staff felt supported and worked well as a team.
• The practice asked staff and patients for feedback about the services they provided.
• The provider dealt with all feedback positively and efficiently.
• Governance arrangements required improvement.

We identified regulations the provider was not complying with. They must:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.
• Ensure specified information is available regarding each person employed.

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 the practice's protocols and procedures for the use of X-ray equipment ensuring compliance with The Ionising Radiations Regulations 2017 and Ionising Radiation (Medical Exposure) Regulations 2017 and taking into account the guidance for Dental Practitioners on the Safe Use of X-ray Equipment.
• 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 did not speak to people who used this service on this occasion as we were reviewing the improvements required from the last inspection.We did however view records and talked with the three managers whilst visiting the practice to help evidence the improvements made.

We spoke with several patients who told us

" the dentist has sorted me out and referred me to the dental hospital for my on-going treatment"

"I've no complaints at all. I'd recommend this place. The place is very clean"