We carried out this announced fully comprehensive follow up inspection on 27 September 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 second dentally qualified inspector.

We had undertaken an announced focused inspection of this service on 7 June 2017 as part of our regulatory functions where breaches of legal requirements were found.

After the focused inspection, the practice wrote to us to say what they would do to meet the legal requirements in relation to each of the breaches and sent evidence of their progress.

We reviewed the practice against three of the five questions we ask about services: is the service safe, effective and well led? You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Swinton Practice Limited on our website at www.cqc.org.uk.

We revisited Swinton Practice Limited as part of this review and checked whether they had followed their action plan and to confirm that they now met the legal requirements. We checked these areas as part of this follow-up comprehensive inspection and found this had been resolved.

We told the NHS England area team that we were inspecting the practice. We received a report of the progress made by the practice and did not receive any further 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 providing well-led care in accordance with the relevant regulations.

Background

Swinton Practice Limited is in Swinton, Manchester and provides NHS and private treatment to adults and children.

There is level access at the rear of the premises for people who use wheelchairs and pushchairs. The practice has a car park and additional street parking is available near the practice.

The dental team includes five dentists, seven dental nurses (two of whom are trainees), one dental hygiene therapist and one receptionist. The clinical team is supported by a practice manager and a practice administrator. There are four treatment rooms.

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 Swinton Practice Limited was the principal dentist.

On the day of inspection we reviewed patient feedback and online reviews. This information gave us a positive view of the practice.

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

The practice is open:

Monday 9am to 6pm

Tuesday to Thursday 9am to 5.30pm

Friday 9am to 3pm.

Our key findings were:

• The practice was clean and well maintained.
• The practice had infection control procedures which reflected published guidance.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available and checked regularly.
• The practice had implemented systems to help them manage risk.
• The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• The practice had introduced thorough staff recruitment procedures.
• The clinical staff provided and reviewed 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 appointment system met patients’ needs.
• The practice had effective leadership and governance. 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 dealt with complaints positively and efficiently.

There were areas where the provider could make improvements and should:

• Review the practice’s arrangements for receiving and responding to patient safety alerts, recalls and rapid response reports issued from the Medicines and Healthcare products Regulatory Agency (MHRA) and through the Central Alerting System (CAS), as well as from other relevant bodies such as, Public Health England (PHE).

• 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.

We carried out this announced focused inspection on 7 June 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 that we were inspecting the practice. We received information which we took into account.

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?

On this occasion we focused on the safe, effective and well led questions.

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 not providing effective 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

Swinton Practice Limited is in Swinton, Manchester and provides NHS and private treatment to adults and children.

There is level access for people who use wheelchairs and pushchairs. The practice has a car park and additional street parking is available near the practice.

The dental team includes five dentists, six dental nurses, one of whom is a trainee, one dental hygienist therapist and one receptionist. The practice has four treatment rooms.

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 Swinton Practice Limited was the principal dentist.

On the day of inspection we collected 13 CQC comment cards filled in by patients. This information gave us a positive view of the practice.

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

The practice is open:

Monday to Thursday 09:00 - 13:00 & 14:00 - 17:30

Friday 09:00 - 13:00.

Our key findings were:

• The practice environment was not clean and cleaning supplies were not stored appropriately.
• The practice did not have infection control procedures which reflected published guidance.
• Staff knew how to deal with emergencies but training was overdue. Appropriate medicines and life-saving equipment were available but the medical oxygen equipment was faulty and masks and airways had expired.
• The systems to help them manage risk could be improved.
• The practice had safeguarding processes in place and staff knew their responsibilities for safeguarding adults and children.
• The practice did not have thorough staff recruitment procedures.
• Not all 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 did not have effective leadership. Staff told us they felt supported and worked well as a team.

We identified regulations that were not being met and the provider must:

• Ensure the practice’s infection control procedures and protocols are suitable giving due regard to guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices and The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance’.

• Ensure the training and learning and development needs of staff members are reviewed at appropriate intervals, an effective process is established for the on-going assessment and supervision of all staff employed.

• Ensure the practice implements the required actions regarding Legionella giving due regard to guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices and The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance’

• Ensure waste is segregated and disposed of in accordance with relevant regulations giving due regard to guidance issued in the Health Technical Memorandum 07-01 (HTM 07-01).

• 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 and the required specified information in respect of persons employed by the practice is held.

• Ensure the practice’s protocols for recording in the patients’ dental care records or elsewhere 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.

• Ensure audits of various aspects of the service, such as radiography and infection prevention and control are undertaken at regular intervals to help improve the quality of service. Practice should also ensure all audits have documented learning points and the resulting improvements can be demonstrated.
• Ensure governance processes are in place relating to:

  • Medicines and Healthcare products Regulatory Agency (MHRA) and through the Central Alerting System (CAS) alerts.
  • Recording, investigating and reviewing incidents.
  • The availability of equipment to manage medical emergencies and training of staff.
  • The awareness of the practice’s safeguarding policy and ensure staff are trained and are aware of their responsibilities.
  • Awareness of the requirements of the Mental Capacity Act (MCA) 2005 and Gillick competency ensuring all staff are aware of their responsibilities.
  • The practice’s sharps procedures giving due regard to the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.

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 and should:

• Review the security of prescription pads in the practice and ensure there are systems in place to monitor and track their use.

• 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 the use of rubber dam for root canal treatment giving due regard to guidelines issued by the British Endodontic Society.

• Review the practice protocols and adopt an individual risk based approach to patient recalls giving due regard to National Institute for Health and Care Excellence (NICE) guidelines.

• Review the practice’s protocols and procedures for promoting the maintenance of good oral health giving due regard to guidelines issued by the Department of Health publication ‘Delivering better oral health: an evidence-based toolkit for prevention’

We visited Swinton Dental Practice on 12 October 2012.

We observed that the reception area and waiting room was clean and bright and displayed appropriate posters promoting good oral hygiene and offering information. A range of leaflets were available and there was a variety of preventive advice and equipment offered.

We saw that policies and procedures were accessible to staff and emergency medical equipment was in place. Decontamination processes were seen to be followed and efforts were made to minimise the risk of cross infection, although some slight improvements could be made around adhering to the uniform policy.

We looked at records, which were factual, up to date and relevant. Patients’ medical information, treatment plans and personal preferences were regularly reviewed.

We spoke with four members of staff, who were suitably qualified for their roles and had undertaken further relevant training. We observed staff members who interacted politely and respectfully with patients.

We spoke with five patients. One patient described the care and treatment as “fantastic” and said they had no complaints. Another said the care and treatment offered was respectful and efficient. Staff were described as "easliy approachable”. All five patients told us that they were offered a very good service.

We observed that comments and complaints would be taken seriously by staff members and used to inform changes and improvements to the service delivered.