We undertook a follow-up focused inspection of St Helens Family Dental Clinic on 12 July 2018. This inspection was carried out to review in detail the actions taken by the provider to improve the quality of care and to confirm that the provider was now meeting the legal requirements.

The inspection was led by a CQC inspector who was supported by a specialist dental adviser.

We undertook a comprehensive inspection of St Helens Family Dental Clinic on the 4 April 2018 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. At a comprehensive inspection we always ask the following five questions to get to the heart of patients’ experiences of care and treatment:

• Is it safe?

• Is it effective?

• Is it caring?

• Is it responsive?

• Is it well-led?

At the comprehensive inspection we found the registered provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Regulation 12 ‘Safe care and treatment’, and Regulation 17 ‘good governance’; not providing safe and well-led care. You can read our report for that inspection by selecting the 'all reports' link for St Helens Family Dental Clinic on our website www.cqc.org.uk.

When one or more of the five questions is not met we require the service to make improvements. We then inspect again after a reasonable interval, focusing on the areas where improvement was required.

As part of this inspection we asked:

• Is it safe?

• Is it well-led?

Our findings were:

Are services safe?

We found this practice was providing safe care in accordance with the relevant regulations.

The provider had made improvements to address the shortfalls identified and respond to the regulatory breach we found at our inspection on 4 April 2018.

Are services well-led?

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

The provider had made improvements to address the shortfalls identified and respond to the regulatory breach we found at our inspection on 4 April 2018.

Background

St Helens Family Dental Clinic is in the centre of St Helens and provides NHS and private dental care and treatment for adults and children.

There is a ramp at the entrance to the practice to facilitate access for wheelchair users and for pushchairs. Car parking is available near the practice.

The dental team includes two dentists, three dental nurses, one of whom is a trainee, a dental hygiene therapist and a receptionist. The team is supported by a practice manager. The practice has two treatment rooms.

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.

During the inspection we spoke to the principal dentist, two dental nurses, the receptionist and the practice manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday and Thursday 9:00am to 7.00pm

Tuesday 9.00am to 4.00pm

Wednesday and Friday 09.00am to 5.30pm

Saturday 9.00am to 12.30pm

Our key findings were:

• Staff knew how to deal with medical emergencies. Appropriate medicines and equipment were available, with the exception of a child sized self-inflating bag.
• The provider had improved their systems to manage risk.
• The provider had staff recruitment procedures in place. We saw these were working well.
• Arrangements were in place for the safe use of X-rays at the practice.

There were areas where the provider could make improvements. They should:

• Review the availability of equipment in the practice to manage medical emergencies taking into account the guidelines issued by the Resuscitation Council (UK) and the General Dental Council; specifically obtain a child sized self-inflating bag.

We carried out this announced inspection on 4 April 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 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 not 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

St Helens Family Dental Clinic is in the centre of St Helens and provides NHS and private dental care and treatment for patients of all ages.

There is a ramp at the entrance to the practice to facilitate access to the practice for wheelchair users and for pushchairs. Car parking is available near the practice.

The dental team includes two dentists, two dental nurses, a dental hygiene therapist and a receptionist. The practice has two treatment rooms.

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.

We received feedback from 43 people during the inspection about the services provided. The feedback provided was positive about the practice.

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

The practice is open:

Monday and Thursday 9:00am to 7.00pm

Tuesday 9.00am to 4.00pm

Wednesday and Friday 09.00am to 5.30pm

Saturday 9.00am to 12.30pm

Our key findings were:

• The practice was clean and well maintained.
• The practice had infection control procedures in place which reflected published guidance.
• The provider had safeguarding procedures in place and staff knew their responsibilities for safeguarding adults and children.
• 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 dental team provided preventive care and supported patients to achieve better oral health.
• The appointment system took account of patients’ needs.
• The provider had a procedure in place for dealing with complaints.
• The practice had a leadership and management structure.
• Staff felt involved and supported and worked well as a team.
• The practice asked patients and staff for feedback about the services they provided.
• The provider had information governance arrangements in place.
• Staff knew how to deal with medical emergencies. Not all the recommended emergency equipment was available.
• The provider had systems in place to manage risk. Risks associated with X-rays were not appropriately managed.
• The provider had staff recruitment procedures in place. References were not always requested and Disclosure and Barring Service checks were not always carried out at an appropriate time.

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

• Ensure care and treatment is provided in a safe way to patients.
• 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 security of NHS prescription pads in the practice.
• Review the practice’s infection control procedures and protocols taking into account the guidelines issued by the Department of Health in the Health Technical Memorandum 01-05: Decontamination in primary care dental practices, (HTM 01 05), and having regard to The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance’. In particular, ensure the steam penetration test is carried out on the vacuum steriliser.
• Review the practice's recruitment procedures to ensure that appropriate checks are completed prior to new staff commencing employment at the practice. In particular, ensure references are obtained.
• Review the practice’s system for recording accidents to staff with a view to preventing further occurrences and ensuring that improvements are made as a result.

We spoke with the registered manager (Dentist), staff and patients waiting for their treatment. This helped us to gain an overview of what people experienced using St Helens Family Dental Clinic.

Care and treatment was planned and delivered in a way that ensured patients safety and welfare. We looked at two patient records. We spoke with the manager regarding the assessment of patients and looked at documents used. One staff member said, “We make sure patients are consulted and agree to the treatment.”

Comments we received from patients were positive about the way they were treated by staff. They were satisfied with the care and support shown to them during the course of their treatment. They told us they found dentists and staff approachable and polite and felt relaxed when visiting the surgery.

Patients we spoke with felt they were given enough information about treatment options. They were kept informed about how their treatment was progressing throughout the process. One patient said, "A great dentist service, I was here last August and really felt comfortable with the staff.”

There were a range of audits and systems in place to monitor the quality of the service being provided.