We undertook a inspection on the 20 February 2018 and then a focused inspection on 31 July 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 inspect , focusing on the area where improvement was required.

As part of this inspection we asked:

• Is it 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.

The provider had not made sufficient improvements to put right all the shortfalls and had not responded to all the regulatory breach(es) we found at our inspection on 20 February 2018.

Background

Townend Dental Practice is in Caterham and provides NHS and private treatment to adults and children.

There is some level access for people who use wheelchairs and those with pushchairs. Car parking spaces, are available near the practice.

The dental team includes 1 dentist, 1 dental nurse, 1 dental hygienist and 1 receptionist. The practice has 1 treatment room.

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 1 dentist, 1 dental nurse and one receptionist. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open: Monday to Friday 09.00- 17.30

Our key findings were:

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/s the provider was/is not meeting are at the end of this report.

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

• Review the way staff are supported to make sure that staff are able to meet the requirements of the relevant professional regulator throughout their employment, such as requirements for continuing professional development.
• Review the practice’s arrangements for ensuring good governance and leadership are sustained in the longer term.
• The provider has partly reviewed the practice's protocols for completion of dental care records. This now needs to take into account guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.
• Review the analysis of the grades for the quality of radiographs to ensure these are correctly recorded over each audit cycle and for each dentist.
• Review the protocols and procedures to ensure staff are up to date with their mandatory training and their Continuing Professional Development (CPD)
• Review the practice’s policies to ensure all documents are providing the latest requirements and guidance.
• Review the practice’s policies to ensure all documents are providing the latest requirements and guidance.
• Review the practice's current performance review systems and have an effective process established for the on-going assessment and supervision of all staff.

We carried out this announced inspection on 20 February 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 second inspector and specialist dental adviser.

We told the NHS England area team that we were inspecting the practice. They provided information which we took into account.

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

Townend Dental practice is in Caterham and provides NHS and private treatment to patients of all ages.

There is some level access for people who use wheelchairs and pushchairs once inside the practice. Car parking spaces, including some for patients with disabled badges, are available near the practice.

The dental team includes 1 dentist, 1 dental nurse, X1 dental hygienist, and 1 receptionist. The practice has 1 treatment room.

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 collected 14 CQC comment cards filled in by patients and spoke with 4 other patients. This information gave us a positive view of the practice.

During the inspection we spoke with 1 dentist and1 dental nurse. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday to Wednesday 08.30 to 17.00 closed for lunch 13.00 to 14.00

Thursday 08.30 to 13.00

Friday closed

Saturday and Sunday Closed

Our key findings were:

• The practice had some infection control procedures which reflected some of the published guidance.
• Staff knew how to deal with emergencies. However not all medicines and life-saving equipment were available.
• The practice had some systems to help them manage risk.
• The practice had suitable safeguarding processes
• The practice did not appear to be clean and well maintained in some areas.
• The practice did not have 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 appointment system met patients’ needs.
• The practice did not have effective leadership. 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 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.

• Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out their duties.

• Ensure specified information is available regarding each person employed.

Full details of the regulations 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 arrangements for receiving and responding to patient safety alerts, recalls and rapid response reports issued from the Medicines and Healthcare products Regulatory Agency (MHRA) and through the Central Alerting System (CAS), as well as from other relevant bodies such as, Public Health England (PHE)
• Review the practice’s arrangement and awareness to ensure that the Accessible Information Standard 2016 is being understood and followed.
• Review staff awareness of the legal precedent by which a child under the age of 16 years of age can consent for themselves and ensure all staff are aware of their responsibilities.
• Review staff training to ensure that all of the staff had undergone relevant training, to an appropriate level, in the Mental Capacity Act,
• Review the practice's protocol and staff awareness of their responsibilities under the Duty of candour to ensure compliance with The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
• Review the analysis of the grades for the quality of radiographs to ensure these are correctly recorded over each audit cycle and for each dentist.
• Review the protocols and procedures to ensure staff are up to date with their mandatory training and their Continuing Professional Development (CPD)
• Review the practice’s policies to ensure all documents are providing the latest requirements and guidance.
• Review its responsibilities to the needs of people with a disability, including those with hearing difficulties and the requirements of the Equality Act 2010.
• Review availability of an interpreter services for patients who do not speak English as a first language.
• Review the practice's protocols for completion of dental care records taking into account guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.
• Review the practice’s audit protocols to ensure audits of various aspects of the service, such as radiography and patients notes are undertaken at regular intervals to help improve the quality of service. Practice should also ensure, that where appropriate audits have documented learning points and the resulting improvements can be demonstrated.
• Review the storage of prescriptions and monitor in line with NHS guidance.
• Review the way staff are supported to make sure that staff are able to meet the requirements of the relevant professional regulator throughout their employment, such as requirements for continuing professional development.
• Consider reviewing the information held on the practice website and NHS choices regarding accessibility of the practice.
• Introduce protocols regarding the prescribing and recording of antibiotic medicines taking into account guidance provided by the Faculty of General Dental Practice in respect of antimicrobial prescribing.

People who used the service told us that they were provided with information about treatment options and the associated costs and were able to ask all the questions they wanted to.

People told us they felt they had enough time and information to make decisions about their treatments. Comments included; "The dentist will take the time to explain to me what treatment I need", "They are really good at fitting you in if you need an appointment quickly" and "I get a breakdown of my treatment and what it costs".

People told us that staff were "Great” and “They provide an excellent service". People said they were treated with respect and their privacy was protected.

People said that the appointment system worked well and that the service was always clean and comfortable and they had no concerns.