We carried out an announced comprehensive inspection at Walton Road Dental Practice on 16 June 2015 and at this time breaches of a legal requirement were found. After the comprehensive inspection the practice wrote to us and told us that they would take action to meet the following legal requirements set out in the Health and Social Care Act (HSCA) 2008:

Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2010, Fit and proper persons employed.

On 23 May 2016 we carried out a focused review of this service under section 60 of the Health and Social care Act 2008 as part of our regulatory functions. The review was carried out to check whether the provider had completed the improvements identified and needed during the comprehensive review in June 2015. 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 Walton Road Dental Practice on our website at cqc.org.uk

The findings of this review were as follows:

We found that this practice was now providing safe care in accordance with the relevant regulations.

• The practice had addressed the issues identified during the previous inspection.
• Its recruitment policy and procedures were suitable and recruitment arrangements were in line with Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Necessary employment checks were in place for staff where appropriate and the required specified information in respect of persons working at the practice was held.
• Other recommended actions had also been taken to improve care and service.

We carried out an announced comprehensive inspection on 16 June 2015. The practice has two dentists supported by two associate dentists. There is a hygienist, five dental nurses, and one receptionist. The practice provides primary dental services to both NHS and private patients. The practice is open Monday 9am – 5pm (alternate Mondays until 6pm), Tuesday 8.30am – 4.30pm. Wednesday and Thursday 9am – 5pm, Friday 8.30am – 1.30pm.

The principal dentist 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.

We viewed 53 CQC comment cards that had been left for patients to complete, prior to our visit, about the services provided. All of the comment cards reflected positive comments about the staff and the services provided. Patients commented that the practice was clean and hygienic; they found the staff very friendly, approachable and caring. They had trust and confidence in the dental treatments and said explanations were clear anmd understandable. Emergency appointments were available on the same day and appointments were usually on time.

The practice was providing care which was safe, effective, caring and responsive in accordance with the relevant regulations. However we found that this practice was not providing well led care in accordance with the relevant regulations and improvements were needed.

Our key findings were:

• The practice recorded and analysed significant events and complaints and cascaded learning to staff.
• Staff had received safeguarding training 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 deal with medical emergencies and appropriate medicines and emergency equipment were readily available.
• Infection control procedures were in place and the practice followed published guidance.
• Patient’s care and treatment was planned and delivered in line with evidence based guidelines, best practice 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 practice staff felt involved and worked as a team.

• The practice sought feedback from staff and patients about the services they provided.

We identified a regulation that was not being met and the provider must:

• Ensure its recruitment policy and procedures are suitable and 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 and the required specified information in respect of persons employed by the practice is held.

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

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

• Ensure that national patient safety and other relevant alerts and guidance is followed and actions taken recorded.
• Improve audits to ensure audit cycles are complete and demonstrate improvements and increase the range of audits undertaken to cover both clinical and non-clinical areas.
• Ensure policies are localised and dated to demonstrate when they were compiled and next due for review.
• Ensure patient feedback such as from the friends and family test, is collated, recorded and acted upon where appropriate.
• Ensure portable appliance testing (PAT) is carried out in accordance with health and safety guidance.

We spoke with five people who were registered as patients with Walton Road dental practice.

People told us that they were happy with the service provided. They felt their dignity was maintained and their privacy protected. For example, people told us that staff dealt with any questions relating to payment or other personal issues in a discreet way, ensuring that private information was not overheard.

They said they were encouraged to ask questions and felt staff had the time to answer their questions.

People who use the service told us that they were provided with good information both about the treatments and the cost of the different treatments. They found the staff were informative about the practice and services provided. They said that staff were pleasant and helpful.

One person told us that they were very nervous when attending the dentist but felt the dentist was aware of this and was always kind and reassuring.

People told us that the dentist showed them a video about how the treatment was carried out which made them feel they were provided with realistic expectations of the procedures they were having.

People told us that at the initial visit they were consulted about what treatment they required and were actively involved in the assessment process to identify their needs. They said that they were required to give full medical details prior to any treatment being carried out and were given information about any risks or side effects that my occur.

One person said they were encouraged to carry out preventative treatment; for example, they were advised how to clean their teeth and follow good dental hygiene practices. Other comments included: “Staff are very caring and reassuring”; “Dentists always explain what the process involves”; “Staff tell you things in a way you can understand”.

People also told us that the clinic was comfortable and accommodating and that appointments were flexible to meet their needs. They said they felt safe and reassured whilst receiving treatment at the dental practice. Comments included: “I have been coming here for many years and am always treated very well”; “All the staff treat me well, they are aware that I am a nervous patient and reassure me that everything will be fine”; “I don’t need to come often but always feel happy with all the treatment provided”; “We are consulted about any medical issues to make sure we are fit to have treatment”.