We carried out this inspection to follow up concerns we originally identified during a comprehensive inspection at the practice on 6 September 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 area 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 and Regulation 19 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 Walton House Practice on our website www.cqc.org.uk.

During this inspection, we spoke with the practice manager and one of the principal dentists. We checked the premises and viewed a range of paperwork in relation to the management of the practice.

Our findings were:

• The provider had made improvements to address the majority of the shortfalls we found at our previous inspection. The provider must now ensure that all newly implemented improvements are embedded and sustained in the long- term in the practice.

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

• Review the practice’s sharps procedures to ensure compliance with the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.

• Review stocks of medicines and the system for identifying and disposing of out-of-date stock.

We carried out this announced inspection on 6 September 2017 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. A CQC inspector, who was supported by a specialist dental adviser, led the inspection.

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

Walton House Dental Practice is a well-established practice in Felixstowe that provides mostly private treatment to patients of all ages. The dental team consists of three dentists, six dental nurses, two hygienists and two practice managers. The practice has three treatment rooms and is open Monday to Friday, from 8.30am to 5pm.

There is portable ramp access for people who use wheelchairs and pushchairs. Car parking is available on site.

The practice is owned by a partnership 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 Walton House Dental Practice is one of the partners, Dr Jonathan Hamilton.

During the inspection we spoke with the principal dentist, two dental nurses and one of the practice managers. We looked at the practice’s policies and procedures, and other records about how the service was managed.

We sent 50 comment cards to the practice prior to our inspection and requested that staff ask patients to complete feedback forms for us. Eight completed cards were returned. We spoke with another three patients during our inspection.

Our key findings were:

• We received good feedback from patients about the quality of the practice’s staff and the effectiveness of their treatment.

• The practice had suitable safeguarding processes and staff knew their responsibilities for protecting adults and children.
• The appointment system met patients’ needs and patients were able to sign up to text and email reminders.
• The practice asked patients for feedback about the services they provided.
• There was no system in place to ensure that untoward events were analysed and used as a tool to prevent their reoccurrence.
• Systems to ensure the safe recruitment of staff were not robust, as essential pre-employment checks were not completed.

• The practice’s sharps handling procedures and protocols did not comply with the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.
• The quality of some dental care records did not meet standards set by the Faculty of General Dental Practice (FGDP).

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

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

• Ensure the practice's recruitment policy and procedures are suitable and the recruitment arrangements 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.

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

• Review the security of prescription pads in the practice and implement systems to monitor and track their use.

• Review the practice’s protocols for the use of rubber dams for root canal treatment taking into account guidelines issued by the British Endodontic Society.
• 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.

We spoke with six people who used the service. All spoke positively about the service. One person told us that they felt staff were, “Very sympathetic with people who are anxious, they use humour, chat with me and are very gentle.”

People said they received a warm welcome from staff and who put them at their ease. One person told us even if they had not visited for a long time when they arrived staff, “Always remember my name."

When we asked three people if they would recommend the service to others they replied, “Oh gosh yes, never had treatment like it,” “Been coming here for years I’ve seen out a few dentists, never been bad but now it’s excellent the new dentists are lovely,” and, "Yes, I think it's a great service."

People told us they felt respected by staff and were fully involved in the decisions about their dental care and treatment. They told us they were given information on how much their treatment would cost. We saw that the provider’s website also included information on payment options.

With their permission, we accompanied two people during their consultation and treatment. We observed staff discuss with people the different treatment options available to them. People were not rushed but given time to decide if they wanted to proceed.

People told us that they found the service to be clean and tidy. Several people commented on the newly decorated waiting room. One person said, “It’s always very beautiful, especially now.”