We carried out this inspection to follow up concerns we originally identified during a comprehensive inspection at the practice on 3 October 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 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 Royston Dental Suite on our website www.cqc.org.uk.

During this inspection we spoke with the principal dentist, the practice manager and a dental nurse. We checked the decontamination room and viewed a range of paperwork in relation to the management of the practice.

Our findings were:

• The provider had made adequate improvement to put right most of the shortfalls we found at our previous inspection. The provider must ensure that the newly implemented improvements are embedded and sustained in the long- term in the practice.

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

• 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 and update all policies and procedures to check they are up to date, and follow national guidance and protocols.

We carried out this announced inspection on 3 October 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. A CQC inspector, who was supported by a specialist dental adviser, led the inspection.

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 Dental Surgery - Hawthorn Drive provides mostly NHS dentistry to patients of all ages. The dental team consists of two dentists, two dental nurses and a receptionist. The practice has two treatment rooms and is open Mondays to Thursdays, from 8.30am to 5pm, and on Fridays from 8.30am to 1pm.

There is portable ramp access for wheelchair and pushchair users at the front of the building.

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 practice is the principal dentist.

During the inspection, we spoke with the principal and associate dentist, and two dental nurses. We looked at the practice’s policies and procedures, and other records about how the service was managed. We collected 21 comment cards filled in by patients prior to our inspection and spoke with another two patients on the day.

Our key findings were:

• We received many very positive comments from patients about the dental care they received and the staff who delivered it, although some patients told us about the turnover of staff at the practice which meant their appointment had been cancelled.

• The practice was clean and well maintained, and had infection control procedures that mostly reflected published guidance.

• Staff knew how to deal with emergencies, although their training was out of date and some life-saving equipment was unavailable.

• The practice had systems to help them manage risk.

• Patients’ needs were assessed and care was planned and delivered in line with current best practice guidance from the National Institute for Health and Care Excellence (NICE) and other published guidance.

• There was no system in place to ensure that untoward events were analysed and used as a tool to prevent their reoccurrence.

• Systems to ensure the safe recruitment of staff were not robust, as essential pre-employment checks had not been completed.

• Staff had not received any appraisal of their performance and regular practice meetings were not held.

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

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care. This includes the recording and monitoring significant events; ensuring that pre-employment checks are undertaken for staff; ensuring appropriate medical emergency equipment is available, improving the quality of audits, and ensuring staff receive regular appraisal of their performance.

We talked with nine people attending appointments and with their permission, we observed two people during their consultation and treatment. All spoke positively about the service. On person told us, “I trust him, he’s a good dentist.” Another person said their dentist was, “Brilliant with kids” and that their child, “Is never made to feel nervous.” A third person said, “My whole family come here now.”

People told us they felt respected by staff and were fully involved in the decisions about their dental care and treatment. One person remarked, “It’s always a worry when you go to the dentist that they will push work on you that doesn’t need to be done, I don’t get that feeling here.”

When we asked people if they would recommend the service to others, they told us they would. One person replied, “Absolutely, from my first visit.” Another person replied, “Yes” and told us that they had started using the dentist after it had been recommended to them.

We observed that the reception and clinical areas were clean and tidy. As we gave short notice of our inspection, we asked people if they always found it to be of the same standard. They told us it did. One person who described the standard of cleanliness as, “Brilliant” said, “I haven’t seen anything that alarms me.”