We undertook an announced focused inspection at The Hollies Dental practice on 24 July 2017. The inspection was carried out to check that improvements to meet legal requirements planned by the practice after our comprehensive inspection on 14 February 2017 had been made.

We inspected the practice against two of the five questions we ask about services: is the service safe and is it well-led?

During our inspection we spoke with the practice manager, one dentist and reviewed a range of documentation.

Are services Safe?

We found that this practice was providing safe care in accordance with the relevant regulations

Are services Well-led?

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

Key findings

The provider had failed to address many of the shortfalls we had identified at our previous inspection. However, immediately following this second inspection, the provider sent us sufficient evidence to demonstrate that the practice was now safe and adequately well-led.

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

• Embed newly implemented improvements into the practice and ensure they are sustained in the long term

We carried out an announced comprehensive inspection on 14 February 2017 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 not 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 Hollies is a well-established dental practice situated in the centre of the village of Chatteris. It provides private dentistry services to adults and NHS dentistry to children. The team consists of two full-time dentists, two part-time hygienists, a practice manager, four dental nurses and a receptionist. There are three treatment rooms, a room for the decontamination of instruments, a reception and waiting area and a number of staff and administrative offices.

The practice opens on Mondays from 8.30am to 7pm; on Tuesdays, Wednesdays and Thursdays from 8.30am to 5pm; and on Fridays from 8.30am to 2.30pm. The practice also opens on a Saturday morning once a month.

The practice manager is registered with the Care Quality Commission (CQC) as the registered manager. 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.

Our key findings were:

• The practice had good facilities overall and was well equipped to treat patients and meet their needs.

• Information from 49 completed Care Quality Commission comment cards gave us a picture of a caring, empathetic and responsive staff. Patients received clear explanations about their proposed treatment and were actively involved in making decisions about it. They were treated in a way that they liked by staff

• 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.

• Access to appointments was good: the practice opened late one evening a week, and on one Saturday a month. Emergency slots were available each day for patients requiring urgent treatment.

• There were sufficient numbers of suitably qualified and competent staff. Members of the dental team were up-to-date with their continuing professional development and supported to meet the requirements of their professional registration.

• The practice proactively sought feedback from staff and patients, which it acted upon.

• Some of the practice’s infection control procedures and protocols did not meet 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’

• Staff were not aware of recent safety alerts from the Medicines and Healthcare products Regulatory Agency (MHRA) that affected dental practice.

• The practice’s recruitment process did not ensure that all relevant checks were undertaken before new staff started work.

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

• Ensure the practice’s infection control procedures and protocols are suitable 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 effective systems and processes are established to assess and monitor the service against the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and national guidance relevant to dental practice. This includes monitoring significant events; responding to national patient safety alerts; improving staff recruitment and fire safety procedures; ensuring infection control audits are undertaken at regular intervals, implementing robust risk assessment, and ensuring policies and procedures are followed.

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 the security of prescription pads in the practice and ensure there are systems in place to monitor and track their use.

People told us they were satisfied with the manner in which staff had spoken to them and that they had been treated with respect at all times. They said their privacy had been upheld when they had received treatment behind closed doors and when staff had ensured that their personal health information remained confidential.

Care records had been completed in full, at each appointment that people had attended. People's records contained all details of the dental treatment that they had received and were up to date with all essential information about their health.

We found the premises were very clean and bright and the environment had been well maintained.