We carried out an announced follow up inspection on 25 August 2016 to ask the practice the following key questions; Are services safe and well-led following the findings from our comprehensive inspection on 16 March 2016.

Our findings were:

Are services safe?

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

Are services well-led?

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

Background

CQC inspected the practice on 16 March 2016 and asked the provider to make improvements regarding safe and well led care. We checked these areas as part of this comprehensive inspection and found this had been resolved.

In March we deemed the provider to be in breach of:

Regulation 12 HSCA 2008 Regulations 2014 Safe Care and Treatment

How the regulation was not being met:

• The provider did not have effective systems and procedures in place to maintain the safety of their premises and the equipment within it.

Regulation 18 HSCA 2008 Regulations 2014 Staffing

How the regulation was not being met:

• Staff did not receive appropriate support, training, professional development, supervision and appraisal as necessary to enable them to carry out their duties.

Regulation 19 HSCA 2008 Regulations 2014 Fit and Proper Persons employed

How the regulation was not being met:

• The practice recruitment arrangements were not 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 are held.

The practice offers NHS primary care dentistry to adult patients and children. The practice is owned by Welcare Dental Practice. There are two dentists, two dental nurses, one trainee dental nurse, one receptionist and a practice manager.

The practice is open Monday to Thursday from 8.00am to 4.00pm, and Fridays from 8.00am to 2.00pm. A longer opening time is offered on a Tuesday until 5pm.

The principal dentist is registered with the Care Quality Commission (CQC) as an individual. 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.

Our key findings in August 2016 were:

• There were suitable arrangements for the purchase, service, maintenance, renewal and replacement of premises (including grounds) and equipment.
• Staff were up to date with their mandatory training and their Continuing Professional Development (CPD)
• The practice's recruitment policy and procedures had been revised in line with Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 which ensured necessary employment checks were in place for all staff and the required specified information in respect of persons employed by the practice was held.
• All furniture in the premises had been risk assessed to ensure they did not cause a breach in infection control. Damaged furniture had been sent for repair.
• Staff had received training in the requirements of the Mental Capacity Act (MCA) 2005 and all staff were aware of their responsibilities under the Act as it related to their role.
• A system had been put in place to check medicines and equipment used to manage medical emergencies adhered to guidelines issued by the Resuscitation Council (UK), and the General Dental Council (GDC) standards for the dental team.

We carried out an announced comprehensive inspection on 16 March 2016 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. The impact of our concerns, in terms of the safety of clinical care, is minor for patients using the service. Once the shortcomings have been put right the likelihood of them occurring in the future is low. We have told the provider to take action (see full details of this action in the Requirement Notices at the end of this report). We will be following up on our concerns to ensure they have been put right by the provider.

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. (see full details of this action in the Requirement Notices at the end of this report). We will be following up on our concerns to ensure they have been put right by the provider.

Background

The practice offers NHS primary care dentistry to adult patients and children. The practice is owned by Welcare Dental Practice. There are two dentists, two dental nurses, one trainee dental nurse, one receptionist and a practice manager.

The practice is open Monday to Thursday from 8.00am to 4.00pm, and Fridays from 8.00am to 2.00pm. A longer opening time is offered on a Tuesday until 5pm.

There is an identified registered person for the practice. 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 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.

Before the inspection eight patients provided feedback about the service. All of these were very positive about the practice staff and the treatment they received.

Our key findings were:

• There was an effective complaints system.
• Staff had received safeguarding training, knew how to recognise signs of abuse and how to report it.
• There were sufficient numbers of suitably qualified staff to meet the needs of patients.
• There was appropriate equipment for staff to undertake their duties, but the practice could not demonstrate that equipment was well maintained and that the building was safe.
• Staff had been trained to manage medical emergencies.
• Infection control procedures were in accordance with the published guidelines.
• Patient care and treatment was planned and delivered in line with evidence based guidelines and current regulations.
• 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.
• Patients could access urgent care when required.
• The practice was not well-led, however staff felt involved and supported and worked well as a team.
• The governance systems were not effective.
• The practice did not seek feedback from staff and patients about the services they provided.

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

• Ensure there are suitable arrangements for fire safety in the building. These arrangements must make sure that they meet the requirements of current legislation and guidance, manufacturers' instructions and the provider's policies or procedures.
• 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 and the required specified information in respect of persons employed by the practice are held.

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 suitability of all furniture in the premises to ensure they do not cause a breach in infection control.
• Review staff awareness of the requirements of the Mental Capacity Act (MCA) 2005 and ensure all staff are aware of their responsibilities under the Act as it relates to their role.
• Review availability of medicines 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.

People told us they were very satisfied with the care and treatment provided at Welcare Dental Surgery. They were given good advice about their treatment requirements. One person told us “I’ve been coming to this practice for a long time, long before these dentists were here. I find I still get a good service. My dentist discusses any problems he can see and procedures he proposes. The appointment system is good. I have to say he (dentist) is very good and talks me through everything. I would describe him as a gentleman, quietly spoken and very nice. No complaints”. Another person told us “I see the lady dentist. She knows her job and I have had no problems. I’m lucky I never need much treatment. I’m always asked to update my health questionnaire at every visit”. There was allocated appointment times on a daily basis available for people with urgent dental care needs that couldn’t wait.

We found suitable arrangements were in place to protect people from abuse and the risk of abuse. All staff employed were subjected to character checks and their registration with the General Dental Council (GDC) verified. People were also protected from the risk of infection and they were treated in a clean hygienic environment.

People attending the practice told us they were aware of how to raise any issue or complaint they may have. They found staff and dentists to be polite and courteous when they attended and they were treated with respect.