We carried out this announced focussed inspection on 9 May 2017 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions.

Yeovil Dental Care received a comprehensive inspection on 28 November 2016 and we found there were significant concerns in how they dealt with incidents and we served a warning notice and told them to be compliant by 7 April 2017. We also served two requirement notices for regulation 17 good governance and regulation 18 staffing. They required improvement in ensuring the service was assessed and monitored to ensure risks were mitigated. This included the servicing of some equipment, ensuring policies and procedures met current legislation and clinical audits undertaken were shared and learned from. They also required improvement in staff support ensuring staff had regular appraisals and training.

The inspection was led by a CQC inspector who was supported by another CQC inspector who had access to a remote specialist dental adviser.

We told the NHS England area team that we were inspecting the practice. They did not provide any information.

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. During this inspection we reviewed the safe and well-led key questions to check if they were now meeting our standards.

Our findings were:

Are services safe?

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

Are services well-led?

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

Background

Yeovil Dental Care is in Yeovil town centre and provides NHS and private treatment to patients of all ages.

There is no level access for patients who use wheelchairs and pushchairs. Patients were referred to a nearby accessible practice. There was no onsite car parking. However there were car parks close to the practice and local public transport was easily accessible.

The dental team includes four dentists (two of which were long term locums), four dental nurses (two of which were trainee dental nurses), one dental hygienist and two receptionists. The practice has five treatment rooms.

The practice is owned by a company and as a condition of registration must have a person registered with the Care Quality Commission as the registered manager. Registered managers 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 registered manager at Yeovil Dental Care was the practice manager.

During the inspection we spoke with two dentists, one dental nurse 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 Friday 8:30am to 5pm
• The practice is closed at weekends.
• There are arrangements in place to ensure patients receive urgent medical assistance when the practice is closed through the out of hours service.

Our key findings were:

• Staff understood how they should report all types of incidents, they were recorded appropriately and learned from and appropriate action taken.
• Staff were mostly up to date with mandatory training. There were a couple of gaps in infection control, information governance and fire safety which were being addressed by the practice manager.
• Equipment that sterilised dental instruments now received the appropriate daily checks and the compressor had now received its annual service.
• Staff immunity status had been confirmed by the practice manager and records held.
• Policies and procedures were reflective of local procedures and were under constant review to ensure they were kept up to date.
• Dentists were now using rubber dams in root canal treatments.
• The infection control lead had received specific training and was confident in her role.
• The practice had now installed a hearing loop for patients with a hearing impairment.
• Staff had received an appraisal in last year apart from two staff. The practice manager was completing these on the day of our inspection.
• There was a clinical audit plan for the year and clinical audits had been completed and learning items identified.
• Changes to the service had been implemented following patient comments.

We carried out an announced comprehensive inspection on 28 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 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

Yeovil Dental Care is a dental practice providing NHS and private dental treatment for both adults and children. The practice is based in the upper floors of a grade two listed building on the High Street in Yeovil, a town situated in Somerset.

Yeovil Dental Care’s corporate owner is Southern Dental Limited. Southern Dental owns approximately 80 practices. The company has created a laudable vision, mission and values statement which are intended to support the ethos of Yeovil Dental Care.

The practice has five dental treatment rooms and a separate decontamination room used for cleaning, sterilising and packing dental instruments. There are two waiting rooms. Access to the practice is via a staircase, there are no lifts available in the practice, which has several floor levels.

The practice employs three dental practitioners, one hygienist, a practice manager, four dental nurses, one trainee dental nurse, three reception staff and a cleaner.

The practice opening hours are between 8.30am – 5.00pm Monday to Friday. The practice is closed at weekends. There are arrangements in place to ensure patients receive urgent medical assistance when the practice is closed. This is provided by an out-of-hours service.

The practice had a registered manager in post at the time of inspection. 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 obtained the views of three patients on the day of our inspection and five patients who completed feedback cards.

Our key findings were:

• We found that the practice ethos provided high quality patient centred care in a relaxed and friendly environment.
• Effective leadership was not provided by senior clinicians and an empowered practice manager.
• Staff had been trained to handle emergencies, appropriate medicines and life-saving equipment was readily available in accordance with current guidelines.
• The practice appeared clean and maintained.
• Infection control procedures were mostly in place and the practice followed published guidance.
• The practice had a lead professional for safeguarding with effective processes in place to safeguard children and adults living in vulnerable circumstances.
• Two medical emergencies had occurred in the practice and neither was fully documented. Appropriate follow up actions following the incidents had not been taken by either the dentist, manager or company. No learning points had been identified, documented or shared with other members of staff.
• Policies, procedures and risk assessments to govern practice activity did not contain relevant local information. The lack of local branding and information diminished their value and usefulness to staff.
• There were not adequate systems in place for checking some of the equipment in a timely way. For example the compressor had not been serviced within the required period and the correct daily checks for the autoclaves were not being carried out and recorded.
• Systems and process did not provide staff with appropriate support, training, professional development, supervision and appraisal as is necessary to enable them to carry out the duties they are employed to carry out.
• The dentists provided care in accordance with current professional and National Institute for Care Excellence (NICE) guidelines.
• Patients could access treatment and urgent and emergency care when required.
• Information from five completed Care Quality Commission (CQC) comment cards gave us a positive picture of a friendly, caring and professional service.

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

• Ensure that where incidents have taken place they are appropriately dealt with, fully documented and reported upon. Learning points are identified, reported upon and fed back to enable staff to respond more appropriately at the practice..
• Ensure that policies, procedures and risk assessments contain local relevant information and are fit for purpose.
• Ensure clear processes are in place and operated effectively to check equipment is serviced and maintained in a timely way and in line with manufacturer and legal requirements.
• Ensure an effective system is operated for collating the records of induction, training and appraisal of staff members.

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

• Review the Disability and Discrimination Act 1995 audit and consider the introduction of a hearing loop for patients with hearing difficulties.