We carried out a focused inspection of Townley House Dental Practice Limited on 29 November 2017. We carried out the inspection to follow up concerns we originally identified during a comprehensive inspection at this practice on 6 March 2017 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions.

At a comprehensive inspection we always ask the following five questions to get to the heart of patients’ experiences of care and treatment:

• Is it safe?
• Is it effective?
• Is it caring?
• Is it responsive to people’s needs?
• Is it well-led?

When one or more of the five questions is 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 areas where improvement was required.

At the previous comprehensive inspection we found the registered provider was providing safe, effective, caring and responsive care in accordance with relevant regulations. We judged the practice was not providing well -led care in accordance with 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 Townley House Dental Practice Limited on our website www.cqc.org.uk.

We also reviewed the key questions of safe and effective as we had made recommendations for the provider relating to these key question(s). We noted that improvements had been made.

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 to put right the shortfalls and deal with the regulatory breach we found at our inspection on 6 March 2017.

We carried out an announced comprehensive inspection on 6 March 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 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

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

Townley House Dental Practice is located in the town of Oundle in a three storey Grade II listed building. The owner also runs two other practices in Lincolnshire and Northamptonshire. The practice provides a wide range of dental services for patients who pay privately for their treatment. The practice has four dental treatment rooms a dedicated decontamination room and a spacious waiting room. Patient services are provided on the ground and first floors of the building.

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.

As part of the inspection, we received feedback through 38 CQC comments cards completed by patients, spoke with other patients as well as eight members of staff during the inspection. Patients commented that they had confidence and trust in the staff who respected them and put them at ease.

Our key findings were:

• There was appropriate equipment for staff to undertake their duties, and equipment was well maintained. Although we found the emergency medical equipment did not have relevant needles and syringes for administering emergency medicines, the practice took immediate action to order the items.
• There were sufficient numbers of qualified staff to meet the needs of patients and staff had received training in managing medical emergencies and had access to relevant equipment.
• Staff had access to training to maintain their ongoing professional development. However, we found staff had not all completed essential training in some key areas.
• Infection control procedures were in place and the practice followed published guidance. However, we found the practice needed to review the risks associated with handling sharp instruments and staff knowledge and understanding of the management of legionella.
• Patient care and treatment was planned and delivered in line with evidence based guidelines and current legislation.
• A number of policies and procedures were in place although some were unclear and required a review in line with best practice guidelines.

• Some governance arrangements were in place for the smooth running of the practice; however some systems and processes used to identify, assess and mitigate risks were not fully established for example, recruitment procedures and systems to safeguard adults and children. Opportunities to learn from complaints and accidents were not always taken.

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

• 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;

  • receiving and responding to patient safety alerts issued from the Medicines and Healthcare products Regulatory Agency (MHRA).
  • implementing an effective system to identify, investigate and review incidents, significant events and near miss incidents so that learning is shared.
  • providing relevant training, to an appropriate level, for all staff in the safeguarding of children and vulnerable adults, the Mental Capacity Act 2005 and Gillick competency. Introduce safeguarding policies which are clear and accessible to staff.
  • implementing a detailed recruitment policy and procedures ensuring the recruitment arrangements are in line with Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations.

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 the practice’s arrangements for storing all medicines in accordance with manufacturer’s instructions. If glucagon is stored in the refrigerator, ensure the fridge temperature is monitored and recorded.
• Review the practice’s waste handling policy to ensure that waste is securely stored in accordance with relevant regulations giving due regard to guidance issued in the Health Technical Memorandum 07-01 (HTM 07-01).
• Review the frequency of fire drills and outstanding actions from the last fire risk assessment.
• Review sharps handling procedures in line with the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.
• Review patient access to health promotion leaflets.