We undertook a follow up focused inspection of Synergy Dental Care – Biddulph on 22 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 Synergy Dental Care – Biddulph on 17 December 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 and was in breach of regulation 17 (Good governance) 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 Synergy Dental Care – Biddulph on our website www.cqc.org.uk.

As part of this inspection we asked:

• Is it well-led?

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 in relation to the regulatory breach we found at our inspection on 17 December 2018.

Background

Synergy Dental Care – Biddulph provides private treatment to adults and children. Treatments include conscious sedation and dental implants.

There is level access to the practice for people who use wheelchairs. There are two small steps to access the ground floor surgery. Car parking spaces are available near the practice.

The dental team includes two dentists, four dental nurses, two dental hygiene therapists, one receptionist and a practice director. The practice has three 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 Synergy Dental Care – Biddulph is the practice director.

During the inspection we spoke with one dental nurse and the practice director. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday to Wednesday from 9:00am to 5:00pm

Thursday from 9:00am to 7:00pm

Friday from 9:00am to 5:00pm

Our key findings were:

• Improvements had been made to the processes for managing the risks associated with Legionella and fire.
• Improvements had been made to the process for managing the risks associated with substances which are hazardous to health.

We carried out this announced inspection on 17 December 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 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

Synergy Dental Care – Biddulph provides private treatment to adults and children. Treatments include conscious sedation and dental implants.

There is level access to the practice for people who use wheelchairs. There are two small steps to access the ground floor surgery. Car parking spaces are available near the practice.

The dental team includes two dentists, four dental nurses, two dental hygienist and therapists, one receptionist and a practice director. The provider also employs a consultant anaesthetist to provide conscious sedation. The practice has three 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 Synergy Dental Care – Biddulph is the practice director.

On the day of inspection, we collected 50 CQC comment cards filled in by patients.

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

The practice is open:

Monday to Wednesday from 9:00am to 5:00pm

Thursday from 9:00am to 7:00pm

Friday from 9:00am to 5:00pm

Our key findings were:

• The practice appeared clean and well maintained.
• The provider had infection control procedures which reflected published guidance.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• Improvements could be made to the processes for managing the risks associated with fire and Legionella.
• The provider had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
• The provider had thorough staff recruitment procedures with the exception of for the anaesthetist.
• The clinical staff provided patients’ care and treatment in line with current guidelines. Sedation services were not governed appropriately, and the provider took the decision to cease this service.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• Staff were providing preventive care and supporting patients to ensure better oral health.
• The appointment system took account of patients’ needs.
• Staff felt involved and supported and worked well as a team.
• The provider asked patients for feedback about the services they provided.
• The provider dealt with complaints positively and efficiently.
• The provider had suitable information governance arrangements.

We identified regulations the provider was not complying with. They must:

• Ensure care and treatment is provided in a safe way to patients.

Full details of the regulation 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 process for ensuring recruitment checks are carried out for visiting specialists.

At our previous inspection we saw that safeguarding checks for staff had not been completed. At this inspection we saw that most people working at Synergy Dental practice now had these in place.

We saw at our previous inspection that the provider had not operated effective recruitment and selection procedures. At this inspection we saw that the policy for recruitment had been reviewed and appropriate amendments had been made.

We spoke with three people who had received treatment at the dental practice and six staff. We reviewed care records and other documents, and observed how people were supported to make decisions and choices about their dental treatment. People receiving treatment at the dental practice told us they were very happy with the care that they received. One person told us, “They are absolutely great. I was very nervous about coming to the dentist because of the previous dentist I went to, but I am fine here”. Another person told us that they were, “Really impressed with the practice. All the staff are friendly and I would recommend it to others”.

People told us they were involved in the planning of their treatment and were treated with dignity and respect. People were communicated with in a professional and friendly manner. We saw that people were cared for and treated by staff that had the appropriate knowledge and skills. During our inspection the practice appeared clean and tidy.

Records were kept securely and could be located promptly when needed and were accurate and fit for purpose. We saw that the provider did not operate effective recruitment and selection procedures.