We carried out a follow-up inspection at The Cosmetic Dental Practice Limited on 21 December 2017.

We had undertaken an announced comprehensive inspection of this service on the 27 June 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 ask about services: are the services well led? You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for The Cosmetic Dental Practice Limited on our website at www.cqc.org.uk.

We revisited The Cosmetic Dental Practice Limited as part of this review and checked whether they now met the legal requirements. We carried out this announced inspection on 21 December 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.

We reviewed the practice against oneof the five questions we ask about services: is the service well-led?

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

Our findings were:

Are services well-led?

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

Background

The Cosmetic Dental Practice Limited is in Grimsby and provides NHS and private treatment to adults and children.

There is level access for people who use wheelchairs and pushchairs. Car parking spaces including one for patients with disabled badges are available adjacent to the practice.

The dental team includes three dentists, three dental nurses (one of whom is a trainee), one dental hygiene therapist and a practice manager (who is also a qualified dental nurse). The practice has two 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 Cosmetic Dental Practice Limited is the compliance advisor.

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

The practice is open:

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

Saturday from 10:00am to 2:00pm

Our key findings were:

• The practice had improved their systems in relation to recruitment and medical emergencies.
• The practice had made some improvements with regards to risk management. Further improvements were needed in relation to the risks associated with Legionella and the Control of Substance Hazardous to Health (COSHH).
• Audits of X-rays and infection prevention and control had been carried out. Improvements were required to the way these audits were completed.
• Not all policies had been amended to reflect the individual nature of the practice.

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

• Review its responsibilities as regards to the Control of Substance Hazardous to Health (COSHH) Regulations 2002 and, ensure all documentation is up to date and staff understand how to minimise risks associated with the use of and handling of these substances.
• Review the practice’s audit protocols of various aspects of the service, such as radiography and infection prevention and control.
• Review the practice's policies and ensure they are specific to the location.

We carried out this announced inspection on 27 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 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

The Cosmetic Dental Practice Limited is in Grimsby and provides NHS and private treatment to adults and children.

There is level access for people who use wheelchairs and pushchairs. Car parking spaces including one for patients with disabled badges are available adjacent to the practice.

The dental team includes three dentists, three dental nurses, one dental hygiene therapist, one receptionists and a practice manager (who is also a qualified dental nurse). The practice has two 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. At the time of the inspection the practice did not have a registered manager in post.

On the day of inspection we received feedback from two patients. This information gave us a positive view of the practice.

During the inspection we spoke with one dentist, two dental nurses, one receptionist 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 to Friday from 9:00am to 5:00pm

Saturday from 10:00am to 2:00pm

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. Minor adjustments were needed to the availability of medicines and equipment for medical emergencies.
• The practice’s process for managing risk could be improved.
• The practice had suitable safeguarding processes and staff knew the signs and symptoms of abuse and felt comfortable to report these to the relevant authorities.
• The practice’s recruitment procedures were not effective. Four members of staff did not have a Disclosure and Barring Service (DBS) check.
• 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.
• The appointment system met patients’ needs.
• Staff did not feel supported by the practice owners and there was not an effective management structure.
• The practice asked patients for feedback about the services they provided. Patient opinion was not fed back to the relevant organisations.
• The practice dealt with complaints positively and efficiently.

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

• Ensure the practice’s sharps handling procedures and protocols are in compliance with the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.
• 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 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 an effective system is established to assess, monitor and mitigate the various risks arising from undertaking of the regulated activities.
• Ensure the provider appoints a registered manager to manage the regulated activities at the location.

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 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).
• Review the practice’s system for the recording, investigating and reviewing incidents or significant events with a view to preventing further occurrences and ensuring that improvements are made as a result.
• Review availability of medicines and equipment to manage medical emergencies giving due regard to guidelines issued by the Resuscitation Council (UK) and the British National Formulary.
• Review the security of prescription pads in the practice and ensure there are systems in place to monitor and track their use.
• Review its responsibilities as regards to the Control of Substance Hazardous to Health (COSHH) Regulations 2002 and, ensure all documentation is up to date and staff understand how to minimise risks associated with the use of and handling of these substances.
• Establish whether the practice is in compliance with its legal obligations under Ionising Radiation Regulations (IRR) 99 and Ionising Radiation (Medical Exposure) Regulation (IRMER) 2000.

As part of our inspection we spoke with a number of people who use the service. They spoke positively about the treatment and support they received. They told us they liked all the staff and confirmed they felt supported to make choices and decisions about the care they received.

Comments included "Staff are wonderful", "Give explanations for every treatment" , "Staff are friendly and helpful" and "I come out smiling not crying."