During our announced comprehensive inspection of this practice on 7 March 2017 we found breaches of legal requirements of to the Health and Social Care Act 2008 in relation to regulation 17- Good Governance.

We undertook this focused inspection to check that the provider now met legal requirements. This report only covers our findings in relation to these requirements. You can read the report from our previous comprehensive inspection by selecting the 'all reports' link for Southlands Dental Practice at www.cqc.org.uk

During our inspection we spoke with the owner and the head dental nurse. We reviewed a range of documentation and checked medical equipment

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 effective 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:

• Embed newly implemented improvements into the practice and ensure they are sustained in the long term.

We carried out an announced comprehensive inspection on 7 March 2017 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

Background

Southlands Dental is a well-established dental practice situated on the outskirts of the market town of Swaffham. It provides private dentistry services to adults and children and serves about 3000 patients. The team consists of four dentists, a dental therapist, four dental nurses, a receptionist and a dental nurse manager. There are three treatment rooms, a room for the decontamination of instruments, a reception and waiting area, and a staff room.

The practice opens on Mondays and Tuesdays from 9am to 7pm; on Wednesdays and Thursdays from 9am to 5.30pm, and on Fridays from 9am to 5pm.

One of the owners is registered with the Care Quality Commission (CQC) as the registered manager. 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.

Our key findings were:

• The practice had good facilities overall and was well equipped to treat patients and meet their needs.

• Information from 34 completed Care Quality Commission comment cards gave us a picture of a caring, empathetic and responsive staff. Patients told us they felt well looked after and that they never felt rushed. However, patients also described areas of the building as a little shabby and commented on holes in walls and cracks in the plaster that required attention.

• Staff had received safeguarding training and took action to protect vulnerable patients when needed.

• 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.

• Access to appointments was good: the practice opened late two evenings a week, and emergency slots were available each day for patients requiring urgent treatment.

• There were sufficient numbers of suitably qualified and competent staff. Members of the dental team were up-to-date with their continuing professional development and supported to meet the requirements of their professional registration. Staff had undertaken specific training in dementia to better understand the needs of patients living with this disease.

• Staff were not aware of recent safety alerts from the Medicines and Healthcare products Regulatory Agency (MHRA) that affected dental practice.

• The identification of potential hazards within the practice was poor. Risk assessments were not detailed enough to ensure that patients and staff were adequately protected.

• The practice’s recruitment process did not ensure that all relevant checks were undertaken before new staff started work and staff did not receive formal appraisal of their performance.

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

• Ensure effective systems and processes are established to assess and monitor the service against the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and national guidance relevant to dental practice. This includes monitoring significant events; strengthening staff recruitment, implementing robust risk assessment, ensuring staff are aware of and follow national guidelines, and providing appraisal for 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

• Review protocols regarding the prescribing and recording of antibiotic medicines in consideration of the guidance provided by the Faculty of General Dental Practice in respect of antimicrobial prescribing and in line with the requirements of the Health and Social Care Act 2015 Code of practice on the prevention and control of infections.

• Review the frequency of infection control audits and ensure that learning points are documented and shared with all relevant staff.

We spoke with people in the waiting room, dental nurses and the owner dentist during our visit to the service. Comments we received were very positive about the standard of cleanliness and range of treatment offered at the Southlands Practice. People told us they were always given an estimate of their treatment with options and associated costs. People also said that they had never had any cause to complain and that the staff were very helpful and polite.