We undertook this follow up visit in response to concerns that we had identified during our previous inspection of the service in 17 October 2013. Our visit was discussed and arranged with the provider in advance so that any disruption to people’s care and treatment were minimised.

At our previous inspection we found that the dentist (who was also the registered provider) had no system in place to support staff to deliver appropriate care. For example through regular appraisals, staff meetings and induction processes for new staff. We found that a complaints system was in place but this was not displayed so that patients were aware of the procedure to make complaints.

We also found that the provider did not have adequate records of staff training and recruitment processes for staff.

The provider sent us an action plan following the inspection in October 2013 detailing the actions they were going to take to address this issue. During this inspection we spoke to the dentist, a receptionist and a dental nurse. We found that the provider had taken on board findings from our previous inspection and had made appropriate changes.

We saw that staff were supported to s deliver care and treatment safely and to an appropriate standard.

A complaints system was now in place and was displayed so that it was easily accessible to patients.

We saw that improvements were being made to records so that accurate information about staff were being kept.

We carried out this inspection to ensure that improvements had been made in relation to concerns identified at our inspection on the 11 April 2013. We spoke with the temporary dental nurse, the receptionist and the practice manager who was also the provider. We did not speak to people who used the service as the outcomes we inspected people would not have been able to comment on.

The staff we spoke with told us they were able to raise concerns they had on a daily basis with the dentist. We found that there was now a formal process for staff to have appraisals however there was still no process to record any discussions with staff. This meant that where staff potentially raised concerns these were not being recorded and therefore no proof of any actions that may be required.

People we spoke with at our previous inspection told us they would raise concerns with the receptionist if they had a complaint, but there was some uncertainty. We found that the provider had prepared a draft document to be displayed to tell people how they could complain, however this was not on display. The provider was awaiting further information before displaying the process.

We found improvements had been made in relation to record keeping since our last inspection. Staff files were now in place and there was some evidence of an auditing system to check on the quality of the service provided to ensure safe practices.

We carried out this inspection to check on the care and treatment of people. Following the inspection we conducted telephone interviews with five people. On the day of the inspection we spoke to the dentist, dental nurse and the receptionist.

The practice consists of a reception/waiting area a treatment room and a toilet which were both wheelchair accessible. The practice also had a ramp for people with mobility issues and a decontamination area.

People told us the practice was good and they are always asked for their consent to treatment. One person said, “They are very supportive to me and always helps me with moving from my wheelchair” and “My consent is always sought before treatment”.

The treatment people received was reflected in their records.

The decontamination process being followed was within current guidelines and the environment was clean and tidy.

The provider did not ensure staff were suitable to work with vulnerable people and of good character before employment commenced.

The provider did not have suitable arrangements in place to ensure staff had professional development, supervision, appraisals and regular meetings.

The provider had a process in place to allow for complaints, but the process was not visible to people. One person said, “I am happy with the service I receive and don’t have a complaint but I wouldn't know how to complain”.

We found that the provider had no proper recording system for checks/audits carried out.