We carried out a follow-up inspection at Strensall dental practice on 16 February 2018.

We had undertaken an announced comprehensive inspection of this service on 24 October 2017 as part of our regulatory functions where a breach of legal requirements was found.

After the comprehensive inspection, the practice wrote to us to say what they would do to meet the legal requirements in relation to the breach. This report only covers our findings in relation to those requirements. We checked whether they had followed their action plan to confirm that they now met the legal requirements.

We reviewed the practice against one of the five questions we asked: are the services well led? You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Strensall dental practice on our website at www.cqc.org.uk.

We revisited Strensall dental practice as part of this review and checked whether they now met the legal requirements. We carried out this announced inspection on 16 February 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.

• Is it well-led?

This question forms the framework for the areas we look at during the inspection.

Our findings were:

Are services well-led?

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

Background

Strensall dental practice is in Strensall, York and provides private treatment to adults and children and has a NHS orthodontic contract for children.

There is ramp access for people who use wheelchairs and pushchairs. Car parking spaces are available at the front and rear of the practice.

The dental team includes three dentists, five dental nurses (one of whom is a trainee), one dental hygienist and a practice manager who is also a receptionist.

The practice has two surgeries, a dedicated room for taking Orthopantomogram (OPG) X-rays, a decontamination room for sterilising dental instruments which is also used as an X-ray room, a kitchen and a general office.

The practice is owned by a partnership 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 Strensall dental practice is one of the principal dentists.

During the inspection we spoke with registered manager 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, Wednesday, Thursday and Friday 9am – 5:30pm

Tuesday 9am – 7pm

Our key findings were:

• Staff were familiar with the need to report and investigate significant events.
• A process was in place to ensure equipment validation and manual instrument cleaning was carried out in line with published guidance.
• Appropriate action was taken to ensure emergency medicines were stored correctly.
• The practice reviewed their risk management processes and made improvements as a result.
• Actions had been taken to ensure the security of patient care records.
• The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children. Awareness of external reporting was now embedded.
• A process had been implemented to ensure appropriate staff disclosure and barring (DBS) checks were in place.
• Management processes and leadership were improved.

We carried out this announced inspection on 24 October 2017 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. We did not receive any information of concern from them.

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

Strensall dental practice is in Strensall, York and provides private treatment to adults and children and has a NHS orthodontic contract for children.

There is ramp access for people who use wheelchairs and pushchairs. Car parking spaces are available at the front and rear of the practice.

The dental team includes three dentists, five dental nurses (one of whom is a trainee), one dental hygienist and a practice manager who is also a receptionist.

The practice has two surgeries, a dedicated room for taking Orthopantomogram (OPG) X-rays, a decontamination room for sterilising dental instruments which is also used as an X-ray room, a kitchen and a general office.

The practice is owned by a partnership 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 Strensall dental practice was one of the principal dentists.

On the day of inspection we collected 44 CQC comment cards filled in by patients. This information gave us a positive view of the practice.

During the inspection we spoke with three dentists, three dental nurses, the dental hygienist 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, Wednesday, Thursday and Friday 9:00am – 5:30pm

Tuesday 9:00am – 7pm

Saturday 9:00am - 12pm

Our key findings were:

• The practice was clean and well maintained.
• The process for reporting, documenting and learning from incidents required embedding within the practice.
• The practice had infection control procedures which mostly reflected published guidance; equipment validation and manual instrument processing could be improved.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available. An improvement was required to monitor and record the temperature of the medicine fridge.
• The practice had some systems to help them manage risk but improvements were required.
• 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; patient record card security was not effective.
• The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children, awareness of external reporting could be improved.
• The practice had detailed staff recruitment procedures; staff disclosure and barring checks required updating.
• The appointment system met patients’ needs.
• Staff felt involved and supported and worked well as a team.
• Management processes and leadership could be improved.
• The practice asked staff and patients for feedback about the services they provided.
• The practice dealt with complaints positively and efficiently.

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 practice's safeguarding policies and ensure all staff are aware of their responsibilities paying particular attention to awareness of external reporting procedures.
• Review the storage of emergency medicines requiring refrigeration to ensure they are stored in line with the manufacturer’s guidance and if stored in the fridge that the temperature is monitored and recorded.
• Review practice's recruitment procedures to ensure that appropriate background checks are completed appropriately according to the role of each staff member.
• Review current policies for obtaining patient consent to care and treatment and ensure they reflect current legislation and guidance and include the requirements of the Mental Capacity Act (MCA) 2005.

People told us that they were able to consent to their care and treatment. Treatment options were discussed and people were given information about fees. People told us they were very happy with the care and treatment they received.

There were appropriate decontamination systems, policies and procedures in place and all of the staff we spoke with demonstrated a clear understanding of infection control. Personal protective equipment was available such as disposal gloves and aprons. This helped to protect people and reduced the risk of infection.

Staff were supported to complete a range of training courses and had access to online journals to keep their professional development up to date.

The dentist had clear systems in place for managing complaints and all of the people we spoke with said they were happy with their care and treatment.