We carried out an announced comprehensive inspection of this practice on 19 October 2015. Breaches of legal requirements were found. After the comprehensive inspection, the practice wrote to us to say what they would do to meet legal requirements in relation to breaches in the Health and Social Care Act 2008 (Regulated Activities) Regulation 16 HSCA (RA) Regulations 2014 Receiving and acting on complaints; Regulation 17 HSCA (RA) Regulations 2014 Good governance; and Regulation 19 HSCA (RA) Regulations 2014 Fit and proper persons employed. We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Thrapston Dental Centre on our website at www.cqc.org.uk

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 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 providing well-led care in accordance with the relevant regulations.

Background

The practice is located in ground floor premises in the village of Thrapston in Northamptonshire. The practice only provides private dental treatments. There is road side parking close to the dental practice. There are two treatment rooms.

Services provided include general dentistry, dental hygiene, crowns and bridges, and root canal treatment.

The practice’s opening hours are – Monday to Thursday: 8:30 am to 5:15 pm; Friday: 8:30 am to 4:30 pm. The practice is closed for lunch between 1:15 pm and 1:45 pm. The practice is closed at weekends.

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

Our key findings were:

• There were systems to record accidents, significant events and complaints, and where learning points were identified these were shared with staff.
• The records showed that apologies had been given for any concerns or upset that patients had experienced at the practice.
• Staff were recruited in line with published guidance and the regulations including receiving a Disclosure and Barring Service (DBS) check.
• The practice followed the relevant guidance from the Department of Health's: ‘Health Technical Memorandum 01-05 (HTM 01-05) for infection control with regard to cleaning and sterilizing dental instruments.
• Documentation identified X-ray machinery was serviced regularly and maintained to a safe working standard.
• The practice was not following the latest guidance when taking X-rays as they were not using rectangular collimation.
• The practice had completed audits of various aspects of the service, such as radiography and dental care records, although the outcomes were not always recorded.

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

• Review the Ionising Radiation Regulations (Medical Exposure) Regulations 2000 and the Department of Health’s: National Radiological Protection Board (NRPB) ‘Guidance notes for Dental Practitioners on the safe use of X-ray equipment’ recommendations in respect of the use of rectangular collimation to limit the radiation dose a patient receives during routine dental X-rays.

• Review the practice policy on auditing to include recording of outcomes, analysis and learning points.

We carried out an announced comprehensive inspection on 19 October 2015 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 not 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 not 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

Thrapston Dental Centre provides private dentistry to approximately 1000 registered patients. It is owned and run by Townley House Dental Practice Limited which runs two other dental practices, one based in Northamptonshire and the other in Lincolnshire. Some employed staff also work at the other practice locations. At the time of our inspection, Thrapston Dental Centre was staffed by two dentists, a practice manager, two dental nurses and a receptionist. There are two treatment rooms available at the practice although we found only one was currently in use for treating patients. The practice opens Monday to Thursday 8.30 to 5.15pm closing at an earlier time of 4.30pm on Fridays. The practice also closes for lunch each day from 1.15 until 1.45pm. Appointments were limited to Monday, Wednesday and Friday afternoons, and all day on Thursdays.

The practice manager 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.

Six patients provided feedback about the service. They told us staff were welcoming, professional and supportive. Patients told us they were happy with the care and support they received. Their treatment plans were always explained and they were made aware of the costs before they started any treatment.

Our key findings were:

• There was appropriate equipment for staff to undertake their duties, and equipment was well maintained.
• Staff had an appropriate level of knowledge about safeguarding patients and knew the processes to follow to raise any concerns.
• There were sufficient numbers of suitably qualified staff to meet the needs of patients.
• Staff had been trained to handle emergencies; appropriate medicines were available although life-saving equipment was not accessible.
• Infection control procedures were in place and the practice followed published guidance.
• Most patient care and treatment was planned and delivered in line with evidence based guidelines and current legislation.
• Patients received clear explanations about their proposed treatment, costs, benefits and risks and were involved in making decisions about it.
• Patients were treated with dignity and respect and confidentiality was maintained.
• The appointment system met the needs of patients and waiting times were kept to a minimum.
• The complaints system was not well established and there were limited systems in place to capture feedback from patients about the service.

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

• Ensure there is an effective process in place for recording accidents and other significant events so that appropriate action and learning takes place.
• Ensure the recruitment policy and procedures are in line with Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 to ensure necessary employment checks are in place for all staff and the required specified information in respect of persons employed by the practice is held.
• Ensure the protocols for the completion of dental records are reviewed giving due regard to guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.
• Ensure audits of various aspects of the service, such as radiography and dental care records are undertaken at regular intervals to help improve the quality of service. Audit outcomes should have documented learning points and the resulting improvements must be demonstrated.
• Ensure that the practice is in compliance with its legal obligations under Ionising Radiation Regulations (IRR) 99 and Ionising Radiation (Medical Exposure) Regulation (IRMER) 2000.
• Review the complaints process and ensure that each stage of the complaints process is recorded and that learning is identified to improve the service.

You can see full details of the regulations not being met at the end of this report.

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

• Review availability of equipment to manage medical emergencies giving due regard to guidelines issued by the Resuscitation Council (UK), and the General Dental Council (GDC) standards for the dental team.
• Review at appropriate intervals the training, learning and development needs of individual staff members and have an effective process established for staff appraisals.
• Tailor all policies and procedures to the specific requirements of Thrapston Dental Centre and fully adopt these as working documents to support the effective management of the practice. Check that records relevant to the management of the practice are available at the practice at all times.
• Review the practice’s infection control procedures and protocols giving due regard to guidelines issued by the Department of Health - Health Technical Memorandum to ensure that the clean and dirty flow of dental instruments is clear. Review the practice’s sharps procedures giving due regard to the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.
• Review records of staff immunity for Hepatitis B so that they are updated.
• Segregate and dispose of waste in accordance with relevant regulations giving due regard to guidance issued in the Health Technical Memorandum 07-01 (HTM 07-01).