We carried out a focused inspection of Stressless Dental Care Holbeach on 22 June 2018.

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

We carried out the inspection to follow up concerns we originally identified during a comprehensive inspection at this practice on 01 November 2017 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 to people’s needs?
• Is it well-led?

When one or more of the five questions is 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(s) where improvement was required.

At the previous comprehensive inspection we found the registered provider was providing safe, effective, caring and responsive care in accordance with relevant regulations. We judged the practice was not providing well-led care in accordance with Regulation 17 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 Stressless Dental Care Holbeach on our website www.cqc.org.uk.

We also reviewed the key questions of safe, effective and responsive as we had made recommendations for the provider relating to these key questions. We noted that most improvements had been made.

Our findings were:

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 put right the shortfalls and deal with the regulatory breach we found at our inspection on 01 November 2017.

We carried out this announced inspection on 1 November 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.

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

Stressless Dental Care is located in Holbeach, near Spalding in Lincolnshire. It provides private dental treatment to patients of all ages. At the time of our inspection, the practice was accepting new patients.

The practice is situated on the first floor of a building which is accessible by stairs. There is a stairlift to assist any patients with mobility problems. There is some limited car parking at the practice. There is also free on street parking near to the practice which does not have time restrictions.

The dental team includes one dentist, one dental nurse and a practice manager. The practice has one treatment room on the first 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 nine 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, the dental nurse and the practice manager. We looked at practice policies and procedures and other records about how the service is managed.

The provider has two practices of the same name. The other practice is based in Boston, Lincolnshire. We did not visit that location as part of this inspection.

The practice has a small number of patients registered and opening hours vary each week according to patient requirements and dentist availability.

Our key findings were:

• The practice objectives included the provision of dental care and treatment of consistently good quality to all patients; and services to meet patients’ needs and wishes.
• We found leadership and governance arrangements required significant improvement..
• We were informed that all staff had been trained to deal with medical emergencies. We found some items of equipment and medicines required in the event of a medical emergency were missing or had expired. An order was placed for the missing and out of date items after our inspection.
• The practice appeared clean and well maintained, although no formal monitoring of arrangements was in place.
• Staff demonstrated awareness of their responsibilities for safeguarding adults and children living in vulnerable circumstances.
• The practice had not adopted a process for the reporting of untoward incidents and shared learning when they occurred in the practice.
• Clinical staff provided dental care in accordance with current professional and National Institute for Care Excellence (NICE) guidelines.
• The practice demonstrated awareness of some of the needs of the local population and took these into account when delivering the service. We noted exceptions in relation to access to interpreter services and the absence of a hearing loop.
• 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 (CPD).
• The practice responded to a complaint received positively, but the policy was out of date and required review.

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 MHRA alerts issued within the past twelve months and take any appropriate action in response.
• Review the practice's recruitment procedures to ensure that appropriate background checks are completed prior to any new staff commencing employment at the practice.
• Review its responsibilities to the needs of people with a disability, including those with hearing difficulties and the requirements of the Equality Act 2010.

Stressless Dental Care Holbeach is a small practice that provides private dental treatment for people. The provider is also the dentist and the staff consists of a practice manager and a dental nurse.

We saw people had been surveyed in August 2012. People indicated treatment costs were explained on the written treatment plan. They also all recorded they had been given time to ask questions. One person we spoke with told us, “The dentist explained what treatment was needed and I signed a consent form.”

A person we spoke with explained they were not confident about visiting the dentist. They told us the dentist had put them at their ease and given them stress relievers to hold. They said, “The dentist was really friendly and talked through everything. She stopped when I asked. She was very gently.”

There were effective systems in place to reduce the risk and spread of infection.

Staff were supported to attend training.

Records showed people had completed a questionnaire about the quality of service they received in August 2012. We saw one person had noted, “Not only is the Dr [name] an outstanding dentist, the surgery facilities are excellent.”