We undertook a focused inspection of Thorne Road Dental Practice on 18 October 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.

We undertook a comprehensive inspection of Thorne Road Dental Practice on 18 June 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 in accordance with the relevant regulations 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 Thorne Road Dental Practice on our website www.cqc.org.uk.

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.

As part of this inspection we asked:

• Is it well-led?

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 18 June 2018.

Background

Thorne Road Dental Practice is in Doncaster and provides NHS and occasional private treatments to adults and children. Thorne Road Dental practice is part of the P B Robinson Group.

There is step access into the practice without adequate space for a ramp to assist people who use wheelchairs. Patients who require step free access are referred to a practice nearby. Car parking is available near the practice and some parking is available on the main road for patients with blue badges.

The dental team includes three dentists, three dental nurses and one receptionist. The practice has four treatment rooms with only three in use.

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 Thorne Road Dental Practice was the area manager.

During the inspection we spoke with the area manager and received e-mail correspondence from the company director to support our findings. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday to Friday 8am – 5pm

Our key findings were:

• The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
• The provider had improved the practice systems to help them manage risk to patients and staff. This included the process to manage safety checks for facilities and electrical equipment.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were now available.
• The provider had reviewed its infection control procedures which now reflected published guidance.
• The provider had put systems in place to monitor and track prescriptions and referrals to other service providers.
• The provider had reviewed its systems of providing preventive care and supporting patients to ensure better oral health.
• The provider had put systems in place to monitor and track prescriptions and referrals.
• The provider had reviewed the responsibilities for the practice cleaner.
• The provider had reviewed its responsibilities in respect to the needs of patients with disabilities.

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

• Review the practice’s processes to ensure that facilities checks are completed in a timely manner, in particular: portable appliance testing.
• Review the practice’s processes in line with the fire risk assessment to ensure the actions required are completed, in particular: In-house smoke detector function checks.

We carried out this announced inspection on 18 June 2018 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. 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

Thorne Road Dental Practice is in Doncaster and provides NHS and occasional private treatments to adults and children. Thorne Road Dental practice is part of the P B Robinson Group.

There is step access into the practice without adequate space for a ramp to assist people who use wheelchairs. Patients who require step free access are referred to a practice nearby. Car parking is available near the practice and some parking is available on the main road for patients with blue badges.

The dental team includes three dentists, three dental nurses and one receptionist. The practice has four treatment rooms with only three in use. The area manager and company director were also present on the inspection day.

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 Thorne Road Dental Practice was the area manager.

On the day of inspection we collected 27 CQC comment cards filled in by patients.

During the inspection we spoke with two dentists, one dental nurse, the receptionist and the area manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday to Friday 8am – 5pm

Our key findings were:

• The practice appeared clean and well maintained.
• The practice staff had infection control procedures, some areas could be improved to bring processes line with published guidance and manufacturer’s instructions.
• Not all appropriate medicines and life-saving equipment were available.
• The practice had systems to help them manage risk, some areas required improvement.
• The practice staff had safeguarding processes and staff knew their responsibilities for safeguarding adults and children; reporting procedures and staff training could be improved.
• The practice had thorough staff recruitment procedures.
• 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 practice was providing preventive care and supporting patients to ensure better oral health. Improvements could be made in relation to treating more complex gum conditions.
• The appointment system met patients’ needs.
• The practice had a leadership and management structure.
• 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 practice staff dealt with complaints positively and efficiently.

We identified regulations the provider was not meeting. They must:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

Full details of the regulation the provider was not meeting are at the end of this report.

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

• Review the practice’s systems to track and monitor prescriptions and referrals sent to other service providers.
• Review the practice’s protocols and procedures for promoting the maintenance of good oral health taking into account the guidelines issued by the British Society of Periodontology (BSP).
• Review the practice’s systems for environmental cleaning to ensure the practice cleaner is not responsible for cleaning clinical dental equipment.
• Review the practice's responsibilities to take into account the needs of patients with disabilities and to comply with the requirements of the Equality Act 2010: in particular people with limited hearing.

We spoke with two people who used the service. They spoke positively about the care and treatment they had received. They told us the treatments were clearly explained and the staff were very good.

Evidence showed people were protected from the risk of infection because appropriate guidance had been followed. People we spoke with told us the practice was always clean although the décor was tired and required some redecoration.

We saw that appropriate checks were undertaken before staff began work.

The practice had an effective well organised system to regularly assess and monitor the quality of service that people received. The practice had a complaints policy and took account of complaints and comments to improve the service. People we spoke with told us they were regularly asked to give feedback in the form of questionnaires. We also saw the results of the questionnaires carried out over the last year, which were mostly positive.