We carried out a focused inspection of You Smile Dental Care on 10 April 2018.

The inspection was led by a CQC inspector who had remote access to telephone support from a dental clinical adviser.

We carried out this inspection to follow up concerns we originally identified during a comprehensive inspection at this practice on 21 November 2017. We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions.

At a comprehensive inspection we always ask the following five questions to get to the heart of patients’ experiences of care and treatment:

• Is it safe?
• Is it effective?
• Is it caring?
• Is it responsive to people’s needs?
• Is it well-led?

When one or more of the five questions is 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(s) where improvement was required.

At the previous comprehensive inspection we found the registered provider was providing safe, effective, caring and responsive care in accordance with relevant regulations. We judged the practice was not providing well-led care in accordance with regulation 17 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 You Smile Dental Care on our website www.cqc.org.uk.

We also reviewed aspects of the key questions of safe and effective as we had made recommendations for the provider relating to these key questions. These particularly related to issues concerning the Mental Capacity Act 2005, record keeping and the Equality Act 2010. We noted that improvements had been made.

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 to put right the shortfalls and deal with the regulatory breach we found at our inspection on 21 November 2017.

We carried out this announced inspection on 21 November 2017 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.

We told the NHS England area team and Healthwatch that we were inspecting the practice. They did not have any relevant information to share with us regarding this dental practice.

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

You Smile Dental Care is situated in the Lincolnshire town of Market Rasen. The practice provides private dental treatment to patients of all ages.

The practice is located on the ground floor with two treatment rooms. There is level access into the practice and the ground floor treatment rooms. There is a pay and display car park a short distance from the practice.

The dental team includes: one dentist; one part time implantologist; one part time dental hygienist; two qualified dental nurses and one practice coordinator.

We carried out this inspection in response to information of concern received by CQC relating to radiography, equipment and staff recruitment.

The practice is owned by an organisation 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 the practice was the practice manager.

On the day of inspection we collected five completed CQC comment cards. This information gave us a positive view of the practice.

During the inspection we spoke with one dentist, two dental nurses, and the practice coordinator. We looked at practice policies and procedures and other records about how the service is managed.

The practice opening hours are: Monday: 8:30 am to 7 pm; Tuesday: 8:30 am to 7 pm;

Wednesday: 8:30 am to 7 pm; Thursday: 8:30 am to 7 pm and Friday: 8:30 am to 5 pm

Some Saturdays: 9 am to 4 pm by appointment only

Our key findings were:

• The practice was clean and well maintained.
• The practice had infection control procedures which followed published guidance.
• The practice asked patients for feedback about the services they provided, and received positive feedback.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available with the exception of an automated external defibrillator (AED).
• The practice had suitable safeguarding processes. Staff had been trained and knew their responsibilities for safeguarding adults and children.
• The practice had thorough staff recruitment procedures.
• Dental care records within the practice were not always complete.
• The clinical staff provided patients’ care and treatment in line with current guidelines.
• Staff treated patients with dignity and respect
• The appointment system met patients’ needs.
• The practice dealt with complaints positively and efficiently.

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

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

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 and should:

• 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 its responsibilities to the needs of people with a disability, including those with hearing difficulties and the requirements of the Equality Act 2010.

We carried out an announced comprehensive inspection on 18 February 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 providing well-led care in accordance with the relevant regulations.

Background

You Smile Dental Care is a single handed private dental practice on the main street in Market Rasen which is a large village in Lincolnshire. The practice is in a building that was previously an accountants and has a bright airy reception with a wheelchair friendly desk. There is two treatment rooms (though only one been used at present) a decontamination room, a separate waiting room and a disabled toilet. There is also a staff room at the back of the building. Access to the practice areas are all on the ground floor. There is free parking within walking distance. The building is accessed from the street and for those patients with limited mobility or wheelchairs there are gates at the side that can be opened electronically by reception to allow patients access to a side door and straight into the practice. there is a small step to the treatment room and the practice has a portable ramp to use if necessary.

There is one dentist, one dental nurse and one receptionist all of whom work full time.

The practice provides private dental treatment to adults and to children. The practice is open Monday to Friday from 9am to 7.30pm and Saturday 9am to 12pm once a month.

The dentist was also the owner of the practice and the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered dentists, 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 registered manager was supported in their role by the practice manager.

Before the inspection we sent Care Quality Commission comment cards to the practice for patients to complete to tell us about their experience of the practice. We received feedback from 19 patients about the services provided. The feedback reflected positive comments about the staff and the services provided. Patients commented that the practice was clean and tidy and that it was welcoming and friendly. They said that they found the staff offered an efficient and professional service and were polite, helpful and kind. Patients said that explanations about their treatment were clear; that they were given time and all options were fully explained. Patients who were nervous commented how the dentist was understanding and patient; they were made to feel at ease and that any questions were answered.

Our key findings were:

• There were sufficient numbers of suitably qualified staff to meet the needs of patients.
• Infection control procedures were in place and staff had access to personal protective equipment.
• Patients’ care and treatment was planned and delivered in line with evidence based guidelines and current legislation.
• Patients received clear explanations about their proposed treatment, costs, benefits and risks.
• Patients were treated with dignity and respect and confidentiality was maintained.
• The appointment system met the needs of patients and waiting times were kept to a minimum where possible.
• The practice was well-led and staff felt involved and worked as a team.
• Staff had been trained to deal with medical emergencies.
• Governance systems were effective and policies and procedures were in place to provide and manage the service.
• Staff had received safeguarding training and knew the processes to follow to raise any concerns.
• All staff were clear of their roles and responsibilities.
• The practice did not have portable suction or an automated external defibrillator (AED)
• Audits and assessments had taken place however it was not clear that recommendations and actions had been completed.
• There was no process for reporting incidents or near misses.
• Servicing and checks of equipment had not been completed in recommended timescales such as servicing of autoclave and x-ray equipment.

There were areas where the dentist could make improvements and should:

• Review availability of equipment 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.
• Review actions from audits and assessments are completed so that resulting improvements can be demonstrated.
• Implement a system and process in place to identify, report and learn from incidents and near misses.
• Review the process so that servicing and checks of equipment are monitored and completed in recommended timescales.

We reviewed six individual dental care records and these showed us that people had been involved in discussions regarding their dental care and treatment and had given their written consent. This and the other evidence reviewed showed us that people’s privacy, dignity and independence were respected.

Those treatment records seen contained clear information in respect of medical history, known allergies, dental examination, consent and in-depth treatment plans that detailed discussions, options and pricings. This showed us that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

Policies and procedures were in place to ensure that people receiving treatment in this service were protected from abuse and adequate safeguards were in place to promote their human rights. This meant that people who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

The practice was clean and generally well maintained. This and the other evidence seen showed us that people were protected from the risk of infection because appropriate guidance had been followed.

We saw that this service carried out a number of audits and addressed any identified concerns. This meant that the provider had an effective system to regularly assess and monitor the quality of service that people receive.