We carried out a follow- up inspection on 26 August 2016 at Well Street Dental surgery.

We had undertaken an announced comprehensive inspection of this service on 3 March 2016 as part of our regulatory functions where breaches of legal requirements were found.

After the comprehensive inspection, the practice wrote to us to say what they would do to meet the legal requirements in relation to the breach. This report only covers our findings in relation to those requirements.

We reviewed the practice against three of the five questions we ask about services: is the service safe, effective and well-led?

We revisited Well Street Dental surgery as part of this review and checked whether they had followed their action plan and to confirm that they now met the legal requirements.

You can read the report from our last comprehensive inspection by selecting the 'all reports' link for Well Street Dental on our website at www.cqc.org.uk.

We carried out an announced comprehensive inspection on 3 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.

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

Well Street Dental provides NHS and private dental treatment to patients of all ages. The services provided include preventative advice and treatment and routine restorative dental care.

The practice staffing consists of a principal dentist, one associate dentist, one trainee dental nurse, one hygienist and a receptionist/nurse.

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.

The practice consists of two treatment rooms, a waiting area for patients and reception area, a staff room and a decontamination room.

The practice opening hours are Monday to Friday 9am to 5pm.

Fourteen patients provided feedback about the service. Patients we spoke with and those who completed comment cards were very positive about the care they received and about the service. Patients told us that they were happy with the dental treatment and advice they had received.

Our key findings were:

• Patients’ care and treatment was planned and delivered in line with current legislation and evidence based guidelines such as from the National Institute for Health and Care Excellence (NICE).
• There were sufficient numbers of suitably qualified staff to meet the needs of patients.
• Patients were treated with dignity and respect and patient confidentiality was maintained.

• The practice had a procedure for handling and responding to complaints.

• There were systems in place to ensure that equipment including the suction apparatus, compressor unit, autoclave and fire extinguishers had been serviced regularly.
• The practice had arrangements for receiving and responding to patient safety alerts issued from relevant external agencies.
• Staff had not undertaken training in key areas such as safeguarding children and adults and infection control. There was lack of oversight of staff’s continuing professional development (CPD) activity and it was not being suitably monitored.

• The practice had ensured that appropriate equipment in line with Resuscitation Council (UK) guidance, was available to respond to a medical emergency.

• Infection control protocols were not being followed in line with recommended national guidance.

• The practice had carried out limited risk assessments to ensure the health and safety of staff and patients.

• Governance systems were not effective. There were a range of policies and procedures in place; however staff had little understanding of the policies with little adaptation to the practice.

• Improvements could be made to ensure dental care records were being suitably completed in line with guidance provided by the Faculty of General Dental Practice.

• The practice had not carried out audits in key areas, such as radiography and infection prevention control (IPC) and record keeping.

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

• Ensure that all of the staff had undergone relevant training, to an appropriate level, in the safeguarding of children and vulnerable adults.
• Ensure the practice’s infection control procedures and protocols are suitable giving due regard to guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices and The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance’.
• Ensure an effective system is established to assess, monitor and mitigate the various risks arising from undertaking of the regulated activities.

• Ensure systems are in place to assess, monitor and improve the quality of the service.

• Ensure audits of various aspects of the service, such as radiography, infection control and dental care records are undertaken at regular intervals to help improve the quality of service. The practice should also ensure that where appropriate audits have documented learning points and the resulting improvements can be demonstrated.

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 recruitment procedures to ensure accurate, complete and detailed records are maintained for all staff.
• Review the practice's protocols for completion of dental care records giving due regard to guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.
• 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.

We spoke with two people and one relative who used the service who said they had positive experiences of their care and treatment. People we spoke with said that they had been treated with dignity and respect by the dentist and other practice team members. The relative we spoke with said, "they [practice staff] are very nice and helpful. I would recommend the service." People were involved in making decisions about their care and treatment and understood the treatment choices available to them. One person told us, “he [the dentist] explained everything and he was very good.”

Care and treatment was assessed and delivered in line with treatment plans to ensure people's safety and welfare. One person who used the service told us, “I’m very nervous of dentists, like 90 per cent of the population and I must say I think he’s {the dentist] brilliant.”

There were effective systems in place to reduce the risk and spread of infection.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. People who used the service said they had confidence in the professionalism and skills of staff who treated them.

People were made aware of the complaints system and how to make comments or suggestions for improvement. There had been no complaints in the past year.