We undertook a focused inspection of The Butts Dental Practice on 21 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 The Butts Dental Practice on 19 October 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 in accordance with the relevant regulations 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 The Butts Dental Practice on our website www.cqc.org.uk.

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.

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 19 October 2018.

Background

The Butts Dental Practice is in Brentford in the London Borough of Hounslow and provides NHS and private treatment to adults and children. The Practice is a training practice and currently has one trainee dentist.

The practice is set out over four floors. There is level access for people who use wheelchairs and those with pushchairs via a lift to the lower basement entrance. The treatment rooms in the basement are accessible for people with restricted mobility and those with pushchairs.

The dental team includes seven dentists, seven dental nurses, two dental hygienists, two receptionists and a practice manager. The practice has eight 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 The Butts Dental Practice is one of the principal dentists

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

The practice is open:

Our key findings were:

• Improvements had been made with regards to obtaining and storing training details. More specifically safeguarding certificates were available for all staff records we reviewed.

• Improvements had been made with recruitment processes. All relevant documents were available on the staff record we reviewed (new member of staff who joined since our last inspection).

• Certificates and documentation relating to risk assessments, gas safety and fire safety were filed appropriately and could be obtained in a timely manner.

• The COSHH folder was up to date and accessible to staff

• Improvements had been made in relation to recording of sedation procedures. A sedation policy was in place and procedures were being recorded appropriately in dental care records.

• Audits were being undertaken and they were complete with areas for improvements identified and clear records of results.

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

• Review the practice's protocols for monitoring and recording the fridge temperature to ensure that medicines and dental care products are being stored in line with the manufacturer’s guidance.

We carried out this announced inspection on 19 October 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

The Butts Dental Practice is in Brentford in the London Borough of Hounslow and provides NHS and private treatment to adults and children. The practice is a training practice and currently has one trainee dentist.

The practice is set out over four floors. There is level access for people who use wheelchairs and those with pushchairs via a lift to the lower basement entrance. The treatment rooms in the basement are accessible for people with restricted mobility and those with pushchairs.

The dental team includes seven dentists, one trainee dentist, seven dental nurses, two dental hygienists, two receptionists and a practice manager. The practice facilities includes eight treatment rooms, two decontamination rooms, two patient waiting areas, staff room and an 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 The Butts Dental Practice was one of the principal dentists.

On the day of inspection, we collected 16 CQC comment cards filled in by patients.

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

The practice is open: 8.30am to 8.00pm Monday to Wednesdays; 8.30am to 5.00pm on Thursdays and 8.30am to 3.00pm on Fridays.

Our key findings were:

• The practice appeared 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.
• 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 dealt with complaints positively and efficiently.
• The practice did not have suitable information governance arrangements.
• The practice staff were aware of safeguarding processes though improvements were required.
• The practice had staff recruitment procedures. However, documents such as interview notes and references were not available in the files we reviewed.
• The practice did not have sufficient systems to help them manage risk.
• The clinical staff provided patients care and treatment in line with current guidelines. Improvements were needed to ensure national guidelines were followed when they were carrying out sedation procedures.

The provider confirmed immediately after the inspection that they had stopped providing dental treatment under conscious sedation beginning with immediate effect and until the shortcomings were rectified. The action that the provider took assured us that there were no risks to patient safety in relation to this area.

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 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 practice's recruitment policy and procedures to ensure accurate, complete and detailed records are maintained for all staff.
• Review staff awareness of the requirements of the Mental Capacity Act 2005 and ensure all staff are aware of their responsibilities under the Act as it relates to their role.
• Review the practice's protocols for medicines management and ensure all medicines are stored and dispensed safely including appropriate labelling.
• Review staff training to ensure that dental nursing staff who assist in conscious sedation have the appropriate training and skills to carry out the role, taking into account guidance
• Review the practice's protocols for completion of dental care records taking into account the guidance provided by the Faculty of General Dental Practice, in particular when recording sedation procedures.
• Review the practice’s arrangements for providing chairside support for dental hygienists, ensuring that a risk assessment is in place if they are lone working.
• Review the practice’s protocols to ensure audits of infection prevention and control are undertaken to improve the quality of the service. Practice should also ensure that, where appropriate, audits have documented learning points and the resulting improvements can be demonstrated.

During our inspection we spoke with six people who use the service. People said that they were able to get an appointment when they needed one. People told us that when they were in pain, or in an emergency, they were able to be seen on the day. They said that even though this was not always with their regular dentist they did not mind. Some comments we received from people were ”all the staff are fantastic”, “they are friendly and nice” and “the dentist knew exactly what was wrong and has given the right treatment”.

People said they were involved in their treatment and most said they felt able to ask questions to clarify what was happening. People said they were told about costs involved in treatment, and we saw information available about the fee structures for NHS or private treatment.

There were appropriate systems for the logging and recording of any complaints received about the service.