We carried out an announced comprehensive inspection of this practice on 9 June 2015. A breach of legal requirements was found. After the comprehensive inspection, the practice wrote to us to say what they would do to meet legal requirements in relation to the breach of Regulation 17.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Shiels and Steward Dental Surgery 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.

Background

CQC inspected the practice on 9 June 2015 and asked the provider to make improvements regarding Regulation 17 of the Health and Social Care Act. We checked these areas as part of this comprehensive inspection and found this had been resolved.

The principal dentist 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.

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

• Review systems in place to ensure that staff are aware of all policies and procedures that are in place.

We carried out an announced comprehensive inspection on 9 June 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 services 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

We carried out an announced comprehensive inspection on 9 June 2015.

The premises consists of a waiting area on the ground floor, a reception area, an accessible treatment room on the ground floor and three treatment rooms on the first floor. There is also a separate decontamination room.

The staff at the practice consists of the principal dentist, two associate dentists, a practice manager (who was on leave on the day of our inspection), two reception staff and three dental nurses. The practice has the services of a dental hygienist who carries out preventative advice and treatment on prescription from the dentists.

The principal dentist (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 spoke with five patients on the day of our inspection. Feedback received from patients was positive in all aspects of the care provided.

Our key findings were:

• Staff were aware of the safeguarding processes to follow to raise any concerns in the practice.
• There were sufficient numbers of suitably qualified staff to meet the needs of patients.
• Staff had been trained to handle emergencies and appropriate medicines and life-saving equipment were readily available.
• Infection control procedures were in place and the practice followed published guidance.
• There was evidence that patient’s care and treatment was not planned and delivered in line with evidence based guidelines, best practice and current legislation.
• Documented evidence was not always evident to show patients received clear explanations about their proposed treatment, costs, benefits and risks and were involved in making decisions about it.
• Patients were treated with dignity and respect and confidentiality was maintained.
• The appointment system met the needs of patients and waiting times were kept to a minimum.
• There was an effective complaints system.
• Governance systems were not effective and there was not a range of clinical and non-clinical audits to monitor and improve the quality of services.

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

• Assess, monitor and improve the quality of the services provided through audits and other checks including following practice recruitment policy.
• Maintain an accurate and complete record in respect of each patient, including a record of the care and treatment provided to the patient.

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:

• Ensure all risks associated with COSHH are approapriately identified and managed.

• Ensure any relevant patient safety alerts are followed up.
• Review the practice’s protocols and procedures for promoting the maintenance of good oral health giving due regard to guidelines issued by the Department of Health publication ‘Delivering Better Oral Health: an evidence-based toolkit for prevention’.
• Ensure all staff familiarise themselves with operating emergency equipment.
• Ensure staff are aware of all policies and procedures that are in place.
• Ensure minutes of meetings are detailed.
• 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

Before our visit, we told the provider that we were coming. During our visit, we spoke with one dental nurse, the provider and observed a consultation/ examination with the permission from a person visiting the surgery. It was not appropriate to speak to people at the practice on the day we visited.

Following our visit, we spoke to four people using the service over the telephone, three staff, and Birmingham East and North Primary Care Trust.

All of the people we spoke with told us that their treatments options were explained to them and they had time to consider their options. We saw that records were detailed about the choices of treatments people had and the decisions people had made. This meant people were consulted about their care so they knew what to expect when they visited. Birmingham East and North Primary Care Trust told us they had no concerns about the practise.

The provider had effective infection control procedures in place. This meant the risk of infection for people using the service was minimised.

All the people we spoke with told us that the staff were very friendly and welcoming. One person told us, “I feel relaxed and staff are very reassuring.

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.

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