We carried out an announced comprehensive inspection of this practice on 21 January 2016. A breach of legal requirement was found. After the comprehensive inspection, the practice wrote to us to say what they would do to meet legal requirements in relation to Good Governance.

We undertook a focused inspection on15 March 2017 to check that they had followed their plan and to confirm that they now met legal requirements. Breaches of legal requirement were found during the focussed inspection in relation to Good Governance and Receiving and Acting on Complaints.

We undertook a further focussed inspection on 8 June 2017 to check 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 and focused inspection, by selecting the 'all reports' link for St Albans Dental Centre 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

St Albans Dental Centre is a general dental practice which is part of the Southern Dental corporate close to St Albans city centre in Hertfordshire. The practice offers predominantly NHS and some private dental treatment to adults and children.

The premises are located on the ground and first floor and consist of four treatment rooms, a reception area, a waiting room and a designated decontamination room.

The practice manager 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.

Our key findings were:

• The practice had completed an infection prevention and control audit. Staff had received training on how the audit tool was to be used.

• Radiography audits (designed to audit the quality of X-rays taken) had been completed on three out of four clinicians. Clinicians had started personal audits of their X-rays these were at a data collection stage, and had not been analysed to establish where improvements could be made.

• Records of complaints made to the practice were kept in the practice complaints folder and escalated to head office.

• Complaints were logged and tracked to ensure that appropriate action was taken and trends were recognised.

We carried out an announced comprehensive inspection of this practice on 21 January 2016. A breach of legal requirement was found. After the comprehensive inspection, the practice wrote to us to say what they would do to meet legal requirements in relation to Good Governance.

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 St Albans Dental Centre on our website at www.cqc.org.uk

Our findings were:

Are services well-led?

We found that this practice was not providing well-led care in accordance with the relevant regulations.

Background

St Albans Dental Centre is a general dental practice which is part of the Southern Dental corporate close to St Albans city centre in Hertfordshire. The practice offers predominantly NHS and some private dental treatment to adults and children.

The premises are located on the ground and first floor and consist of four treatment rooms, a reception area, a waiting room and a designated decontamination room.

The practice manager 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.

Our key findings were:

• The practice had a fire risk assessment completed shortly after the comprehensive inspection. At the time of the follow up inspection the listed recommendations had not all been implemented or addressed.

• An infection control audit had been completed, but only once in the year preceding the follow up inspection. National guidance recommends infection control audits are carried out six monthly. Certain questions had been answered incorrectly.

• Radiography audits (designed to audit the quality of X-rays taken) had been completed on one out of four clinicians, and in that one case had not generated an action plan for improvement at the time of the inspection.

• Records of complaints made to the practice were incomplete, and were not always passed to head office as per the practice policy.

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

• Ensure an accessible system is established for identifying, receiving, recording, handling and responding to complaints by service users and other persons in relation to the carrying on of the regulated activity.

We carried out an announced comprehensive inspection on 21 January 2016 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.

St Albans Dental Centre is a general dental practice which is part of the Southern Dental corporate close to St Albans city centre in Hertfordshire. The practice offers predominantly NHS and some private dental treatment to adults and children.

The premises are located on the ground and first floor and consist of four treatment rooms, a reception area, a waiting room and a designated decontamination room.

The staff at the practice consist of a practice manager, three dentists, a dental hygienist, a receptionist, a qualified dental nurse and three trainee dental nurses. The practice manager also managed two other Southern Dental practices.

The practice manager 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.

Our key findings were:

• There was an induction and training programme for staff to follow which ensured they were skilled and competent in delivering safe and effective care and support to patients.
• The practice ensured staff maintained the necessary skills and competence to support the needs of patients.
• There were some effective systems in place to reduce the risk and spread of infection. We found the treatment rooms and equipment were mostly visibly clean.
• There were systems in place to check equipment had been serviced regularly, including the dental air compressor, autoclaves, fire extinguishers, oxygen cylinder and the X-ray equipment.

• We found the dentists and dental hygienist regularly assessed each patient’s gum health and dentists took X-rays at appropriate intervals.

• The practice kept up to date with current guidelines when considering the care and treatment needs of patients.

• Staff had been trained to handle emergencies and appropriate medicines and life-saving equipment were readily available.
• 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.
• Staff demonstrated knowledge of the practice whistleblowing policy and were confident they would raise a concern about another staff member’s performance if it was necessary.
• At our visit we observed staff were kind, caring and professional. Some staff had worked at the practice for a long time and demonstrated they knew patients well when they greeted them.

• We received feedback from 40 patients. Comments we received indicated patients felt they received very good service, detailed explanations of available treatments and helpful advice from a practice team who were very polite and caring.
• The practice had a well-publicised complaints process. However, the practice was not following its own policy, did not have a system for recording verbal complaints and information about the complaints received by the practice did not correlate with information sent to us from the head office prior to our inspection.
• There was a lack of an effective system to assess, monitor and improve the quality and safety of the services provided.
• The practice was not undertaking X-ray audits which was not in accordance with current guidance.There was no person identified to maintain oversight of the practice in the absence of the practice manager.
• The risks associated with ascending and descending the internal stairs had not been adequately mitigated.

You can see full details of the regulations not being met at the end of this report.

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

• Ensure an effective system is established to assess, monitor and improve the quality and safety of the services provided.
• Ensure audit learning points are shared with all relevant staff and resulting improvements can be demonstrated as part of the audit process.

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

• Review the practice complaints procedures to ensure there is an effective process in place for acknowledging, recording, investigating and responding to complaints, concerns and suggestions made by patients.

• Review the risk associated with the steep internal stairs to ensure patients, staff and visitors are adequately supported to ascend and descend the stairs safely.
• Ensure a range of suitable literature or information is available for patients in relation to maintaining good oral and general health.