We undertook a focused inspection of Thornaby Dental Centre on 22 November 2018

This inspection was carried out to review in detail the actions taken by the registered provider to improve the quality of care and to confirm that the practice was now meeting legal requirements.

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

We undertook a comprehensive inspection of Thornaby Dental Centre on 22 August 2018 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We found the registered provider was not providing well led care and was in breach of 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 Thornaby Dental Centre on our website www.cqc.org.uk.

As part of this inspection we asked:

• Is the practice well-led?

When one or more of the five questions are 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.

Our findings were:

Are services well-led?

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

The provider had made improvements in relation to the regulatory breach we found at our inspection on 22 August 2018.

Background

Thornaby Dental Centre is in Stockton-On-Tees and provides NHS and private treatment to adults and children.

There is a step at the entrance to the practice and a portable ramp is available to aid those who require it – for example people who use wheelchairs and those with pushchairs. Car parking spaces, including a designated space for blue badge holders, are available near the practice.

The dental team includes the principal dentist, three associate dentists, five dental nurses (of whom two are trainees), a dental hygiene therapist, two receptionists and a practice manager. The practice has four treatment rooms all situated on the ground floor.

The practice is owned by an individual who is the principal dentist there. They have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run.

During the inspection we spoke with the principal dentist 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, Tuesday, Thursday and Friday 9am to 5.30pm

Thursday 8am to 5.30pm

Saturday by appointment only.

Our key findings were:

• The practice had improved their systems to help them manage risk.
• The practice had effective leadership.
• A culture of continuous improvement was evident.
• The provider had improved their staff recruitment procedures.
• Training of staff was monitored efficiently.
• Interpreter services were available for people who needed it.

There were areas where the provider could make improvements. They should:

• Review the practice’s protocols for ensuring that clinical staff who cannot demonstrate adequate immunity for vaccine preventable infectious diseases, including the vaccine for Hepatitis B, have risk assessments carried out to mitigate any risks to their health.

We carried out this unannounced inspection on 22 August 2018 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We planned the inspection, in response to concerns we received, 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.

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

Thornaby Dental Centre is in Stockton On Tees and provides NHS and private treatment to adults and children.

There is a step at the entrance to the practice and a portable ramp is available to aid those who require it – for example people who use wheelchairs and those with pushchairs. Car parking spaces, including a designated space for blue badge holders, are available near the practice.

The dental team includes the principal dentist, two associate dentists, six dental nurses (of whom three are trainees), a dental hygiene therapist, three receptionists and a practice manager. The practice has four treatment rooms all situated on the ground floor.

The practice is owned by an individual who is the principal dentist there. They have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run.

On the day of inspection, we spoke with three patients who provided us with positive feedback about the practice.

During the inspection we spoke with three dentists, five dental nurses, the dental hygiene therapist, two receptionists 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 and Wednesday  8am to 5.30pm

Tuesday, Thursday and Friday 9am to 5.30pm

Saturday 8am to 1pm by appointment only.

Our key findings were:

• The practice appeared clean and well maintained.
• The provider had infection control procedures which reflected published guidance.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• The practice staff had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
• The practice had some systems to help them manage risk to patients and staff. The provider needed to review their protocols for undertaking risk assessments for lone working and hazardous substances. The practice’s legionella and fire risk assessments identified actions which were not recognised nor implemented. Safety alerts were not received for medical equipment.
• The provider did not undertake thorough staff recruitment procedures for all staff employed.
• Training of staff was monitored; this process required strengthening to be effective.
• 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 dental professionals were providing preventive care and supporting patients to ensure better oral health.
• The appointment system met patients’ needs.
• The practice had leadership which required strengthening.
• Staff felt involved and supported and worked well as a team.
• The practice asked staff and patients for feedback about the services they provided.
• The provider dealt with complaints positively and efficiently.
• The provider had suitable information governance arrangements.

We identified regulations the provider was not complying with. They must:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.

Full details of the regulations the provider is not meeting are at the end of this report.

There were areas where the provider could make improvements. They should:

• Review the use of interpreter services (rather than family or friends) for people whose first language is not English.