We undertook a focused inspection of Westgate Dental Practice on 6 December 2018

2018.

This inspection was carried out to review in detail the actions taken by the registered provider to improve the quality of care and to confirm that the practice was now meeting legal requirements.

The inspection was led by a CQC inspector who was supported by a specialist dental adviser.

We undertook a comprehensive inspection of Westgate Dental Practice on 17 July 2018 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We found the registered provider was not providing well led care and was in breach of regulations 12, 17 and 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 Westgate Dental Practice on our website www.cqc.org.uk.

As part of this inspection we asked:

• Is the practice well-led?

When one or more of the five questions are 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.

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 in relation to the regulatory breach we found at our inspection on 17 July 2018.

Background

Westgate Dental Practice is in Newcastle upon Tyne and provides NHS and private treatment to adults and children.

There is a small step in front of the practice and a portable ramp is available for those who require it. Car parking spaces are available near the practice.

The dental team includes a principal dentist, two associate dentists, four dental nurses (one of whom is a trainee), a dental hygienist, a practice manager and a receptionist. The dental practice is in a three-storey listed building and has four treatment rooms.

The practice is owned by an individual who is the principal dentist there. They have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run.

During the inspection we spoke with the principal dentist, two associate dentists, four dental nurses and the practice manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday to Thursday 8.45am to 5.45pmFriday 8.45am to 5pm.

Our key findings were:

• The practice had effective leadership.
• A culture of continuous improvement was evident.
• The provider had improved their staff recruitment procedures.
• Training of staff was monitored efficiently.
• Policies were re-written and updated where applicable.
• The provider had improved their systems to help them manage risk.
• Risk assessments were undertaken or updated for legionella, fire, hazardous substances, lone-working and sharps.
• Sedation protocols were reviewed to follow national guidance.
• Infection prevention and control had improved and all sterilisation equipment records were available.
• Medicines and life-saving equipment were available as described in recognised guidance.
• Referrals and prescriptions were monitored efficiently.
• Interpreter services were available for people who needed it.
• Dental professionals were adequately supported by a trained member of the dental team when treating patients in a dental setting.
• Dental care records were reflective of the guidance provided by the Faculty of General Dental Practice.

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

• Review the fire safety risk assessment and ensure that any actions required are complete and ongoing fire safety management is effective.

We carried out this announced inspection on 17 July 2018 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. The inspection was led by a CQC inspector who was supported by a specialist dental adviser.

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

Westgate Dental Practice is in Newcastle upon Tyne and provides NHS and private treatment to adults and children.

There is a step in front of the practice which may be a barrier for people who use wheelchairs and those with pushchairs. To aid these people, a small portable ramp is available. Car parking is available near the practice.

The dental team includes a principal dentist, two associate dentists, five dental nurses (one of whom is a trainee), a dental hygienist, a practice manager and a receptionist. The dental practice is in a three-storey Victorian building and has four treatment rooms.

The practice is owned by an individual who is the principal dentist there. They have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run.

On the day of inspection, we collected 15 CQC comment cards filled in by patients.

During the inspection we spoke with the two associate dentists, four dental nurses and the practice manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday to Thursday 8.45am to 5.45pmFriday 8.45am to 5pm

Our key findings were:

• The practice appeared clean and well maintained.
• The practice had infection control procedures which reflected published guidance with the exception of a few minor areas and sterilisation equipment records.
• Staff knew how to deal with emergencies. Not all appropriate medicines and life-saving equipment were available as described in recognised guidance.
• The practice had very few systems to help them manage risks. The principal dentist had not undertaken a legionella risk assessment, a fire risk assessment of the premises nor had undertaken risk assessments for hazardous substances held on-site.
• The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children. Staff underwent safeguarding training annually; the level of this training was unknown.
• The provider did not undertake thorough staff recruitment procedures.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• The practice was providing preventive care and supporting patients to ensure better oral health in line with current guidelines.
• The appointment system met patients’ needs.
• The practice leadership required reviewing. A culture of continuous improvement could be demonstrated and the principal dentist was aware this process required further strengthening.

• Staff felt involved and supported and worked well as a team. The practice manager was empowered and required more support to perform their role effectively.
• The practice asked staff and patients for feedback about the services they provided.
• The practice dealt with complaints positively and efficiently.
• The practice had suitable information governance arrangements.

We identified regulations the provider was not meeting.

They must:

• Ensure care and treatment is provided in a safe way to patients.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.

Full details of the regulations the provider was not meeting are at the end of this report.

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

• Review the practice’s systems for monitoring referrals to ensure they are efficient.
• Review the current staffing arrangements to ensure all dental care professionals are adequately supported by a trained member of the dental team when treating patients in a dental setting taking into account the guidance issued by the General Dental Council.
• Review the practice's protocols for completion of dental care records taking into account the guidance provided by the Faculty of General Dental Practice.

We spoke to two patients and we were told that the practice was ‘very good’ and that ‘all staff are friendly, cheerful and always helpful’. We were told that there were ‘no issues or concerns ‘. They said staff spoke to them well and listened to their queries appropriately; they also said that if they had any problems they knew who to speak to.

They told us that options available were fully explained and how much it would cost. Each patient was given a copy of their treatment plan and the cost of their treatment.

The practice manager told us how the practice supported staff through training, peer group support and appraisals to make sure they were working to the best clinical guidelines for their professions.

Patients told us that they had been given access to their treatment plans and were confident that they could see their records if needed.