We carried out this announced inspection on 11 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 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.

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

Are services effective?

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

Are services caring?

We found this practice was providing caring services in accordance with the relevant regulations.

Are services responsive?

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

Are services well-led?

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

Background

St Mark’s Dental Surgery is in Cambridge and provides both NHS and private treatment to patients of all ages. The practice opens on Monday to Friday, from 9 am to 5pm. It opens later on a Wednesday evening until 7pm. There is ramp access for people who use wheelchairs and those with pushchairs.

The dental team includes three dentists, an orthodontist, three dental nurses and two reception staff. The practice has three 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.

On the day of inspection we collected 23 CQC comment cards filled in by patients and spoke with one other patient.

During the inspection we spoke with one dentist, the practice manager, both receptionists and an agency nurse We looked at practice policies and procedures and other records about how the service is managed.

Our key findings were:

• We received positive comments from patients about the dental care they received and the staff who delivered it.

• The practice had suitable safeguarding processes and staff knew their responsibilities for protecting adults and children.

• The appointment system met patients’ needs and the practice opened late one evening a week. Text and email appointment reminders were available.

• The practice was clean and well maintained, and had infection control procedures that reflected published guidance.

• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.

• The clinical staff provided patients’ care and treatment in line with current guidelines.

• There was no system in place to ensure that untoward events were analysed and used as a tool to prevent their reoccurrence.

• Systems to ensure the safe recruitment of staff were not robust, as essential pre-employment checks had not been completed.

• Risk assessment was limited and recommendations to improve safety for patients and staff were not always implemented.

• Staff did not receive regular appraisal of their performance and did not have personal development plans in place.

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. This includes the recording and monitoring of significant events; managing complaints effectively, implementing recommendations from risk assessments, strengthening audit systems and ensuring staff receive regular appraisal of their performance.

• Ensure the practice's recruitment policy and procedures are suitable and the recruitment arrangements are in line with Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 to ensure necessary employment checks are in place for all staff.

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 storage of dental care products and medicines requiring refrigeration to ensure they are stored in line with the manufacturer’s guidance and the fridge temperature is monitored and recorded.

• Review the practice’s protocols for recording in the patients’ dental care records the reason for taking the X-ray and quality of the X-ray giving due regard to the Ionising Radiation (Medical Exposure) Regulations (IR(ME)R) 2000. Review the analysis of the grades for the quality of radiographs to ensure these are correctly recorded over each audit cycle and for each dentist.

• Review the practice's responsibilities to the needs of people with a disability, including those with hearing difficulties and those who do not speak English and the requirements of the Equality Act 2010.

We undertook a focused inspection of St Mark Dental Surgery on 13 November 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.

Previously, we had undertaken a comprehensive inspection 11 April 2018 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We found the registered provider 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 Denteam Dental Care 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 areas where improvement was required.

As part of this inspection we asked:

• Is it well-led?

Background

St Mark’s Dental Surgery is in Cambridge and provides both NHS and private treatment to patients of all ages. The practice opens on Monday to Friday, from 9 am to 5pm. It opens later on a Wednesday evening until 7pm. There is ramp access for people who use wheelchairs and those with pushchairs.

The dental team includes two dentists, an orthodontist, two dental nurses and two reception staff. The practice has three treatment rooms.

The practice is owned by an individual who is the principal dentist there. He has 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 with the principal dentist and a dental nurse/receptionist. We looked at practice policies and procedures and other records about how the service is managed.

Our findings were:

The provider had made satisfactory improvements in relation to the regulatory breaches we found at our previous inspection and was now was providing well-led care in accordance with the relevant regulations. These improvements must be sustained in the long-term.

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

• Review the practice's protocols for monitoring and recording the fridge temperature to ensure that medicines and dental care products are being stored in line with the manufacturer’s guidance.

• 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.