We carried out an announced responsive follow up inspection on 23 January 2017 to ask the practice the following key questions; Are services well-led?

We had undertaken an announced comprehensive inspection of this service on 13 June 2017 as part of our regulatory functions where a breach of legal requirements was found.

Our findings were:

Are services well-led?

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

Background

The Forge Dental Practice is located in the main street and on a bus route. There is a large waiting area providing a comfortable space and two surgeries. Children are provided for with a selection of toys and books. The practice offers private dental treatment and has a small NHS contract for children only. The practice has two treatment rooms, a waiting area and a local decontamination facility away from the treatment rooms. All areas are on the first floor with a stairlift to enable patients with limited mobility to access the practice.

The practice has two dentists, a visiting hygienist who attends the practice once a week, two qualified dental nurses who also fulfil the receptionist role.

One of the nurses is also the practice manager as the provider/ principal dentist only works in the practice one day a week and lives a considerable distance from the practice. The practice manager has recently taken up this role and is in the process of implementing appropriate quality management and governance arrangements.

The principal dentist is the registered provider who is registered with the Care Quality Commission to manage the service. 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 practice is open Monday to Thursday, 08:30am to 5.00pm Fridays 09.00am – 12.30pm. The practice is closed at weekends. Out of hours number is available via the practice answerphone.

We reviewed feedback from patients which was positive about the care they received from the practice. They commented staff put them at ease, listened to their concerns and provided an excellent service in which they had confidence in the dental care provided.

Our key findings were:

• The practice was clean and well maintained.
• Infection control procedures were robust and the practice followed published guidance.
• Staff had been trained to handle emergencies and appropriate medicines and life-saving equipment were readily available in accordance with current guidelines.
• The practice had systems in place manage risks.
• Staff understood and received safeguarding training and knew how to recognise signs of abuse and how to report it.
• Safe recruitment of staff was in place.
• Treatment was well planned and provided in line with current guidelines.
• Patients were treated with dignity and respect and confidentiality was maintained.
• The appointment system met patients’ needs.
• The practice was well-led by an empowered practice manager and the principal dentist.
• Staff felt involved, supported and worked well as a team.
• The practice sought feedback from staff and patients about the services they provided.
• Complaints were responded to in an efficient and responsive manner.
• In one treatment room we saw the X ray arm was partially broken and were told it was irreparable but it was still in use.

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

• Review the use of the damaged X-ray equipment and seek advice from the Radiation Protection Advisor.

We carried out an announced comprehensive inspection on 13 June 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 this practice was providing safe care in accordance with the relevant regulations.

Are services effective?

We found this practice was providing effective care in accordance with the relevant regulations.

Are services caring?

We found this practice was providing caring services in accordance with the relevant regulations.

Are services responsive?

We found this practice was providing responsive care in accordance with the relevant regulations.

Are services well-led?

We found this practice was not providing well-led care in accordance with the relevant regulations.

Background

The Forge Dental Practice is located in the main street and on a bus route. There is a large waiting area providing a comfortable space and two surgeries. Children are provided for with a selection of toys and books. The practice offers private dental treatment and has a small NHS contract for children only. The practice has two treatment rooms, a waiting area and a local decontamination facility away from the treatment rooms. All areas are on the first floor with a stair lift to enable patients with limited mobility to access the practice.

The practice has two dentists, a visiting hygienist who attends the practice once a week, two qualified dental nurses who also fulfil the receptionist role. One of these nurses is also the practice manager as the provider/ principle dentist only works in the practice one day a week and lives a considerable distance from the practice. The practice manager has recently taken up this role and is in the process of implementing appropriate quality management and governance arrangements.

The principal dentist is the registered provider who is registered with the Care Quality Commission to manage the service. 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 practice is open Monday to Thursday, 08:30am to 5.00pm Fridays 09.00am – 12.30pm. The practice is closed at weekends. Out of hours number is available via the practice answerphone.

We reviewed 15 CQC comment cards that had been left for patients to complete, prior to our visit, about the services provided. In addition we spoke with five patients on the day of our inspection. Feedback from patients was positive about the care they received from the practice. They commented staff put them at ease, listened to their concerns and provided an excellent service in which they had confidence in the dental care provided.

Our key findings were:

• There were systems in place to help ensure the safety of staff and patients. These included safeguarding children and adults from abuse. However systems for maintaining the required standards of infection prevention and control and responding to medical emergencies required some attention which the practice manager was aware of and took immediate action to address.

• The dental practice had risk management processes including health and safety in place but limited clinical governance processes to ensure the safe management of medical emergencies and supply of prescription only medicines.

• The practice had some system to monitor and improve the quality of the service; including through audits, however these were not operated effectively to ensure adequate quality monitoring of service provision.

• Premises were well maintained and a tour of the building confirmed that cleaning and infection control systems were in place. The treatment rooms were well organised and equipped, with good light and ventilation.

• In one treatment room we saw the X ray arm was broken and were told it was irreparable but it was still in use.

• There were systems in place to check equipment had been serviced regularly, including the air compressor, autoclave, fire extinguishers, oxygen cylinder and the X-ray equipment.

• There were usually sufficient numbers of suitably qualified staff who mostly maintained the necessary skills and competence to support the needs of patients. When staff shortages occurred agency staff were employed.

• Most staff were up to date with current guidelines and the practice was led by the principal dentist.

• Staff were kind, caring, competent and put patients at their ease.

• Patients commented they felt involved in their treatment and that it was fully explained to them.

• Common themes from patients spoken with were that they felt they received good care in a clean environment from a helpful practice team.

• Information about how to complain was available and easy to understand. The practice had not received any complaints in the last 12 months.

When we visited The Forge Dental Surgery we spoke to five patients, a dentist, a dental nurse and a receptionist. We found that patients were informed about their treatment options and that treatment plans had been provided to include the costs. Patients told us about the surgery, "I look forward to coming to the dentist", "they (the dentist) give me good advice" and "I can't praise highly enough".

There was information available in reception about the treatments available and how to contact the dentist in an emergency when the surgery was closed, which meant that patients had been well informed and supported when they were in pain. There was also information about how to make a complaint.

The surgery had infection control procedures and facilities available to complete the decontamination of instruments effectively. We found that systems in the practice had been audited to help ensure that they were effective. People had completed quality surveys and given their suggestions which had been taken into consideration.