We undertook a focused inspection of St Helen’s Dental Surgery on 09 July 2018. 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 led by a CQC inspector who was supported by a specialist dental adviser.

Previously, we undertook a comprehensive inspection of St Helen’s Dental Surgery on 09 January 2018 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. During that inspection we found the registered provider was providing a safe, effective, caring and responsive service but was not providing well led care in accordance with the relevant regulations 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 St Helen’s Dental Surgery on our website www.cqc.org.uk.

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.

As part of this inspection we asked:

Is it well-led?

Our findings were:

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 breach we found at our inspection on 09 January 2018.

Background

The practice is located in Ashby De La Zouch, a market town in North West Leicestershire. It provides NHS treatment to patients of all ages. At the time of our inspection, the practice was accepting new NHS patients for registration.

There is level access for people who use wheelchairs and pushchairs. Car parking spaces are available in the practice’s own car park.

The dental team includes the practice manager, one dentist, four dental nurses, (including the practice manager) and one receptionist. The practice has two treatment rooms, both located on the ground floor.

The practice is owned by an individual who is the principal dentist there. They 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 practice is open: Monday to Thursday from 8:45am to 12pm and from 1:45pm to 5:45pm and on Friday from 8:45am to 1:45pm.

Our key findings were:

The practice had implemented a policy and process for reporting and investigating significant events.

The practice had implemented systems for monitoring and improving quality, for example audit activity.

Risk assessments had been conducted in areas such as legionella and fire safety.

The practice showed they were receiving and reviewing patient safety and medicines alerts from the Medicines and Healthcare Products Regulatory Authority.

Policies had been reviewed or were newly implemented; they were specific to the practice.

Recruitment processes had been strengthened to reflect legislative requirements.

Processes for ensuring all emergency medicines and equipment were available had been improved.

The practice had implemented a safer sharps system.

Rubber dam was available and was in use by the dentist.

Staff awareness of the requirements of the Mental Capacity Act 2005 and Gillick competence had increased.

The practice had obtained a hearing loop to help any patients with hearing problems.

Systems for ensuring security of prescription pads had improved; we noted this could be further strengthened.

The provider had implemented a system for monitoring and improving quality of the service.

We found that the provider had taken steps to mitigate the risks relating to the health, safety and welfare of patients and others who might be at risk.

We carried out this announced inspection on 9 January 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.

We told the NHS England area team and Healthwatch that we were inspecting the practice. They did not provide any information for us to take into account.

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

The practice is located in Ashby De La Zouch, a market town in North West Leicestershire. It

provides NHS treatment to patients of all ages. At the time of our inspection, the practice was accepting new NHS patients for registration.

There is level access for people who use wheelchairs and pushchairs. Car parking spaces are available in the practice’s own car park.

The dental team includes the practice manager, one dentist, four dental nurses, (including the practice manager) and one receptionist. The practice has two treatment rooms, both located on the ground floor.

The practice is owned by an individual who is the principal dentist there. They have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run.

On the day of inspection we collected four CQC comment cards filled in by patients. This information gave us a positive view of the practice.

During the inspection we spoke with the dentist, four dental nurses, (including the practice manager who worked as a nurse) and the receptionist.

We looked at patient feedback, practice policies and procedures and other records about how the service is managed.

The practice is open: Monday to Thursday from 8.45am to 12:45pm and from 1:45pm to 5:45pm and on Friday from 8:45am to 1:45pm.

Our key findings were:

• Staff had been trained to deal with medical emergencies and appropriate medicines and most of the lifesaving equipment was readily available in accordance with current guidelines. We noted some exceptions.
• The practice appeared clean and was generally well maintained.
• Staff demonstrated awareness of their responsibilities for safeguarding adults and children living in vulnerable circumstances. We found that the practice’s safeguarding policy required review and some staff training was due for completion.
• The practice had not adopted a robust process for the reporting of significant events and untoward incidents.
• Clinical staff provided dental care in accordance with current professional and National Institute for Care Excellence (NICE) guidelines.
• Staff recruitment processes required improvement to ensure they complied with legislative requirements.
• Patients had access to routine treatment and emergency care when required.
• Staff received most training appropriate to their roles and there was evidence of continuing professional development).
• We found areas where ineffective leadership was in place and governance arrangements required strengthening.

We identified regulations the provider was not meeting. They must:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

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 sharps procedures and ensure the practice is in compliance with the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.
• Review the practice’s protocols for the use of rubber dam for root canal treatment taking into account guidelines issued by the British Endodontic Society.
• Review staff awareness of the requirements of the Mental Capacity Act (MCA) 2005 and the principle of young people’s competency and ensure all staff are aware of their responsibilities as it relates to their role.
• Review the practice’s responsibilities to the needs of people with a disability, including those with hearing difficulties and the requirements of the Equality Act 2010.
• Review the security of prescription pads in the practice and ensure there are systems in place to track and monitor their use.

We spoke with six patients and four staff members. We reviewed five care records, and also saw information relating to five staff members.

The patients told us that their treatment had been discussed and that they were able to make an informed decision about their treatment. One patient told us ”the dentist always explains the treatment and asks for my consent.”

All the patients spoke highly regarding the quality of care and kindness displayed by the staff. One patient told us ”the staff are always polite, welcoming and respectful.”

Staff were observed wearing uniforms and other appropriate personal protective equipment. None of the patients we spoke with had any concerns about the cleanliness of the practice.

We saw that all dental treatment was provided by a qualified dentist and the dental nurses who were registered with the General Dental Council (GDC), the professional regulator of dental practitioners.

We also saw that a range of audits, risk assessments and checks were carried out to ensure systems and practices were working effectively.