We undertook a focused inspection of St. Mary Street Dental Practice on 13 February 2019. 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.

We undertook a comprehensive inspection of St. Mary Street Dental Practice on 22 June 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 safe and well led care and was in breach of regulations 12 (Safe Care and Treatment), 17 (Good Governance) and 19 (Fit and proper persons employed) 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. Mary Street Dental Practice on our website www.cqc.org.uk.

As part of this inspection we asked:

• Is it safe?

• Is it well-led?

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.

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 in relation to the regulatory breaches we found at our inspection on 22 June 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 in relation to the regulatory breaches we found at our inspection on 22 June 2018.

Background

St. Mary Street Dental Practice is in Chippenham, Wiltshire and provides private treatment for adults and children.

The dental team includes the dentist, one dental nurse, a receptionist and a practice manager. The practice has one treatment room.

The practice is owned by a company and as a condition of registration must have a person registered with the Care Quality Commission as the registered manager. Registered managers 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 registered manager at St. Mary Street Dental Practice is the practice manager.

During the inspection we spoke with the principal dentist, the dental nurse, 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 to Friday 8:00am – 5:00pm.

Our key findings were:

• The practice was providing care and treatment in a safe way to patients.
• The practice had implemented effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
• The practice had implemented a system to ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.
• The practice ensured that all relevant information is available in respect of each person employed.

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

• Review staff training to manage medical emergencies taking into account the guidelines issued by the Resuscitation Council (UK) and the General Dental Council.
• Review the practice’s protocols for ensuring that all clinical staff have adequate immunity for vaccine preventable infectious diseases.
• Review the training, learning and development needs of individual staff members at appropriate intervals and ensure an effective process is established for the on-going assessment, supervision and appraisal of all staff.

We carried out this announced inspection on 22 June 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 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. Mary’s Street Dental Practice is in Chippenham, Wiltshire and provides private treatment to adults and children.

The dental team includes a dentist, a dental nurse, a trainee dental nurse who is also the receptionist and a practice manager. The practice has one treatment room, a reception area and a waiting room. The practice is open Monday to Friday 8:00am – 5:00pm.

The practice is owned by a company and as a condition of registration must have a person registered with the Care Quality Commission as the registered manager. Registered managers 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 registered manager at St. Mary’s Street Dental Practice was the practice manager.

On the day of inspection we collected 28 CQC comment cards filled in by patients.

During the inspection we spoke with a dentist, a trainee dental nurse and the practice manager. We looked at practice policies and procedures and other records about how the service is managed.

Our key findings were:

• The practice staff had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• The clinical 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 practice was providing preventive care and supporting patients to ensure better oral health.
• The appointment system met patients’ needs.
• Staff felt involved and supported and worked well as a team.
• The practice asked staff and patients for feedback about the services they provided.
• The practice staff had suitable information governance arrangements.
• The practice did not have infection control procedures which reflected published guidance.
• Staff had not completed training in emergency resuscitation and basic life support (BLS) every year.
• Appropriate life-saving equipment were not available.
• The practice did not have systems to help them manage risk.
• The practice did not have thorough staff recruitment procedures
• The practice did not have an effective leadership and culture of continuous improvement.

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
• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.
• Ensure specified information is available regarding each person employed

Full details of the regulation/s the provider was/is not meeting are at the end of this report.

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

• Review the Accessible Information Standard to ensure people who have a disability, impairment or sensory loss get information in a format that they can access and understand

We spoke with people as they attended for appointments. One person told us they had registered with the practice because after looking at the provider’s website they felt the practice would be supportive. They told us they had a historical fear of dentists but that they had found this practice to be very caring and described the dentist as having a “gentle approach”. They told us that the dentist had been very precise in describing what their responsibilities were towards their own oral health and that the procedures they recommended had been effective in the removal of plaque. This meant the dentist could proceed with other stages of treatment. The person told us they were ”happy with the service and care”. Another person told us they were “very, very happy” and that their family had also moved to the practice.

People were involved in decisions about their treatment and were given written estimates of the cost involved. Records showed the treatment people received and recorded their consent.

The recruitment of staff included all relevant checks. Staff we spoke with felt supported and enjoyed their work. Staff were provided with a range of training opportunities including child protection and safeguarding vulnerable adults. When we spoke with staff they were aware of their responsibilities in this area.

There were good arrangements for cleaning and maintaining good control of infection and the provider had systems in place monitor the quality of service provided.