We carried out an announced focussed inspection on 20 October 2016 following a previous inspection in January 2016 where we found shortfalls in the governance arrangements for the practice. On 20 October 2016, we inspected the practice to ask the following key question; are services well-led?

Our findings were:

Are services well-led?

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

Background

Dhody’s Ltd provides private dental treatment mainly for adults. The practice is situated in a converted commercial property. The practice has one dental treatment room and a separate decontamination room used for cleaning, sterilising and packing dental instruments. Dental care is provided on the ground floor which also has a reception and waiting area. The practice is open 9.00am to 12.00pm and 4.00pm to 8:00pm Monday to Friday. The practice had one dentist who is supported by a trainee dental nurse/practice manager, a part time dental hygienist and a receptionist.

The practice owner is the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons 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 was supported in their role by a practice manager who is also training to be a dental nurse.

Our key findings were:

• All the requirements set out by the Care Quality Commission in relation to well-led key question at the previous practice inspection had been met.
• Since our last visit the provider had put into place more robust governance systems to underpin the clinical care provided.
• We found that an empowered practice manager oversaw the maintenance of these clinical governance systems.
• Monitoring systems and audit had been improved.
• The practice had appropriate medicines and life-saving equipment readily available in accordance with current guidelines.
• Infection prevention control methods followed the guidance set out in HTM 01 05 (national guidance for infection prevention control in dental practices’) in relation to meeting essential quality requirements.
• The practice environment was clean, tidy and clutter free.
• The control of Legionella was managed in accordance with national guidelines.
• Information provided to patients with respect to fees was clear and unambiguous and displayed clearly in the patient waiting area and on the practice website.
• The practice had introduced an additional in house system to capture patient feedback which supplemented the online and social media systems.

We carried out an unannounced comprehensive inspection on 19 January 2016 to ask the practice the following key questions; Are services safe, effective, caring, responsive and well-led?

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

Dhody’s Ltd is a relatively new dental practice which has provided private treatment for around two years mainly for adults. Children are seen free of charge if the parent is a patient of the practice. The practice is situated in a converted commercial property. The practice has one dental treatment room and a separate decontamination area adjacent to the treatment room for cleaning, sterilising and packing dental instruments. Dental care was provided on the ground floor which also has a reception and waiting area.

The practice is open 9.00am to 8:00pm Monday to Friday. The practice had one dentist who was supported by a trainee dental nurse/practice manager a part time dental hygienist and a receptionist.

The practice owner is the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons 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 was supported in their role by a practice manager who is also training to be a dental nurse

Our key findings were:

• The practice had a safeguarding policy in place with processes for escalating safeguarding issues for children and adults should the need arise.
• The practice had a system in place for recording incidents with the practice meeting used as the vehicle for shared learning. No incidents were recorded in 2015.
• A Infection control policy was in place and procedures followed mainly reflected published guidance. We highlighted areas for improvement during the inspection and these were dealt with promptly by the practice manager.
• The dentist received annual update training to handle emergencies in the dental chair.
• Emergency equipment for dealing with medical emergencies in the dental chair mainly reflected published guidelines. We found a number of shortfalls and these were dealt with promptly by the practice manager whilst we were on site and shortly after we left.
• We saw that when a recent member of staff was recruited important pre-employment checks were undertaken in accordance with current regulations.
• The dentist provided dental care in accordance with current professional and National Institute for Care Excellence (NICE) guidelines.
• We sought the view of patients on the day of our visit and they reported that the standard of care was good.
• The service was aware of the needs of the local population and considered these in how the practice was run.
• Patients could access treatment and urgent and emergency care when required.
• The dentist had received regular continued professional development (CPD) in accordance with maintaining their professional registration.
• The practice captured patient feedback using an on line format, we noted that the practice responded to each of the comments posted on line.
• The small size of the dental team meant that there was a possibility of professional isolation occurring in the practice. It was also apparent that these factors posed difficulties in terms of keeping abreast with contemporary systems of dental practice management.

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

• Ensure availability of medicines and equipment to manage medical emergencies giving due regard to guidelines issued by the British National Formulary, the Resuscitation Council (UK), and the General Dental Council (GDC) standards for the dental team.

• Ensure the practice’s infection control procedures and protocols 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 an effective system is established to assess, monitor and mitigate the various risks arising from undertaking of the regulated activities.
• Ensure systems in place to assess, monitor and improve the quality of the service are effective and where appropriate audits have documented learning points and the resulting improvements can be demonstrated.

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

• Consider accessing professional assistance to help with the management of the practice and obtaining peer support such as that available through the various professional associations available for dentists and practice managers.