We carried out a follow-up inspection at Wynyard Dental Practice on the 7 March 2017.

We had previously undertaken an announced comprehensive inspection of this service on the 8 November 2016 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 each of the breaches. This report only covers our findings in relation to those requirements.

We reviewed the practice against one of the five questions we ask about services: is the service well-led? You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Wynyard Dental on our website at www.cqc.org.uk.

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

Our findings were:

Are services well-led?

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

Background

Wynyard Dental is a family-run dental practice which provides private treatment to patients of all ages. The practice is situated in a central complex within Wynyard Village, Teesside. There are two spacious treatment rooms each with their own decontamination area for sterilising dental instruments, two waiting areas (one with a dedicated children’s’ area) and a reception. There are ample car parking spaces in front of the practice. Access for wheelchair users or pushchairs is possible via the step-free ground floor entrance.

The practice is open Monday to Friday 0900 -1730 and Saturday 0900-1300.

The dental team is comprised of two principal dentists, an associate dentist, two qualified dental nurses and two receptionists. The practice is currently recruiting a third qualified dental nurse.

The provider is registered with the Care Quality Commission (CQC) as a partnership. A condition of their registration states the regulated activity procedures are to be managed by an individual who is registered as a manager. An application was underway for a registered manager to be appointed. 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.

Our key findings were:

• Various audits (including infection prevention and control and radiography) and risk assessments (including fire, Legionella and health and safety) had been carried out and action plans were implemented.
• Robust recruitment procedures were now in place.
• Documentation was retained for the checks of the sterilisation equipment.
• Practice policies were specific to the practice, dated and reviewed. All staff had signed to indicate they had read and understood the policies.
• Staff training, learning and development was appropriately reviewed. All staff had undergone training to an appropriate level in the safeguarding of adults and vulnerable children.
• The practice had re-registered with the Information Commissioner’s Office (ICO).
• Arrangements for receiving and responding to patient safety alerts, recalls and rapid response reports were in place.

• The practice had adequate procedures for undertaking patient and staff satisfaction surveys to help improve the quality of service.

We carried out an announced comprehensive inspection on 8 November 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 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

Wynyard dental is a family-run dental practice which provides private treatment to patients of all ages. The practice is situated in a central complex within Wynyard Village, Teesside. There are two spacious treatment rooms each with their own decontamination area for sterilising dental instruments, two waiting areas (one with a dedicated children’s’ area) and a reception. There are ample car parking spaces in front of the practice. Access for wheelchair users or pushchairs is possible via the step-free ground floor entrance.

The practice is open Monday to Friday 0900 -1730 and Saturday 0900-1300.

The dental team is comprised of two principal dentists, an associate dentist, two qualified dental nurses and two receptionists. The practice is currently recruiting a third qualified dental nurse.

The provider is registered with the Care Quality Commission (CQC) as a partnership. A condition of their registration states the regulated activity procedures are to be managed by an individual who is registered as a manager. The provider had not ensured a registered manager had been appointed. 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 spoke with one of the registered partners and the associate dentist to advise this must be completed as part of their registration contract; they were considering the associate dentist to be appointed.

We reviewed nine CQC comment cards on the day of our visit; patients were very positive about the staff and standard of care provided by the practice. Patients commented they felt involved in all aspects of their care and found the staff to be helpful, respectful, friendly and were treated in a clean and tidy environment.

Our key findings were:

• The practice was visibly clean and free from clutter.
• The practice had systems for recording incidents and accidents.
• Staff received annual medical emergency training.
• Dental professionals provided treatment in accordance with current professional guidelines.
• Patients could access urgent care when required.
• Complaints were dealt with in an efficient and positive manner.
• An Infection prevention and control policy was in place. We saw sterilisation procedures followed recommended guidance. We were advised the practice did not keep any documentation for the checks of the sterilisation equipment.
• The practice did not have an effective management structure to regularly review the needs of staff (including their training) practice protocols or policies.
• The practice policies were not specific to the practice, not dated nor reviewed.
• Dental nursing and reception staff had not undergone training in safeguarding adults and vulnerable children, mental capacity or information governance.
• Recruitment procedures were not consistent.

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

• 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 is held.
• Ensure the practice implements the required control measures specified by their Legionella risk assessment 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 the practice facilities are fit for the purposes to which they are being used. This includes assessing the practice’s disability access and fire risk.
• Ensure audits of various aspects of the service, such as infection prevention and control and radiography are undertaken at regular intervals to help improve the quality of service. The practice should also ensure all audits have documented learning points and the resulting improvements can be demonstrated.
• Ensure the training, learning and development needs of staff members are reviewed at appropriate intervals and an effective process is established for the on-going assessment and supervision of all staff employed.

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:

• Review the practice's policies to ensure they contain appropriate details, are practice specific, dated and reviewed at regular intervals.
• Review the practice's protocols for completion of dental records giving due regard to guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.
• Review the practice responsibilities in regards to the Control of Substances Hazardous to Health (COSHH) Regulations 2002 to ensure all documentation is present and up to date and staff understand how to minimise risks associated with the use of and handling of these substances.
• Review the practice’s procedure for maintaining logs of all sterilisation equipment 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.

• Review the necessity to re-register the practice with the Information Commissioner’s Office (ICO) at appropriate intervals.
• Review the practice’s arrangements for receiving and responding to patient safety alerts, recalls and rapid response reports issued from the Medicines and Healthcare products Regulatory Agency (MHRA) and through the Central Alerting System (CAS), as well as from other relevant bodies such as, Public Health England (PHE).
• Review the practice’s safeguarding policy and ensure all staff have had training at an appropriate level, in the safeguarding of children and vulnerable adults.
• Review the practice’s procedures for undertaking patient and staff satisfaction surveys to help improve the quality of service.

During the inspection we looked at the various records the provider held. These included staff and patients records; and other records relating to the safe running of the practice. We found that relevant records were being kept; they were accurate and easily accessible to staff. This meant the provider was ensuring that people received appropriate care and support.

We did not speak with any patients during this inspection as none attended the practice whilst we were there.

We spoke with three people who used the service. People said that they were very happy and that they saw the dentist on a regular basis. They confirmed the dentist and dental nurses and hygienist always explained what they were doing and what the treatment options were. One person we spoke with told us, “The dentist explained what I needed and how much it would cost.” Another person said, “They always make time for you, it’s a family atmosphere.”

We saw that treatment plans were developed and people’s care was delivered in accordance with their plans.

We found that people were protected from the risk of infection because processes were followed to ensure care was delivered in a clean and hygienic environment.

People were cared for by suitably qualified, skilled and experienced staff.

People told us that they would feel comfortable in raising a concern or complaint with staff working at the practice.

We found that records were not always maintained.