We carried out this inspection to follow up concerns we originally identified during a comprehensive inspection of the practice on 4 July 2017 under Section 60 of the Health and Social Care Act 2008.

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 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. However, 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 Bar Hill Dental Practice on our website www.cqc.org.uk.

During this inspection, we spoke with the principal dentist and practice manager. We checked the premises and reviewed a range of documentation in relation to the management of the practice.

Our findings were:

• The provider had made good improvements to put right the shortfalls we found at our previous inspection. The provider must ensure that these newly implemented improvements are embedded and sustained in the long- term in the practice.

We carried out this announced inspection on 4 July 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. A CQC inspector who was supported by two specialist dental advisers led the inspection.

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

Bar Hill Dental Clinic is a well-established practice that provides mostly private treatment to patients of all ages. The dental team consists of four dentists, three dental nurses, a hygienist and a practice manager, who serve about 2500 patients. The practice has three treatment rooms and is open Monday to Thursday from 9am to 5pm and on Fridays from 8am to 2pm. The hygienist works at the practice three times a month from 7am until 2pm.

There is level access for people who use wheelchairs and pushchairs. Car parking spaces are available near the practice.

The principal dentist, who is also the owner, is registered with the Care Quality Commission (CQC) as an individual. 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.

During the inspection we spoke with three dentists, two dental nurses and the practice manager. We looked at the practice’s policies and procedures, and other records about how the service was managed.

We sent 50 comment cards to the practice prior to our inspection and requested that staff ask patients to complete feedback forms for us. The practice manager told us that none had been completed. However, following our inspection we were sent two completed cards from patients who were happy with the service they had received. We spoke with another three patients during our inspection.

Our key findings were:

• The practice had suitable safeguarding processes and staff knew their responsibilities for protecting adults and children.

• Members of the dental team were up-to-date with their continuing professional development and supported to meet the requirements of their professional registration.

• Staff felt well supported by the practice owner, and there were regular practice meetings. The practice listened to its patients and staff and acted upon their feedback.

• The appointment system met patients’ needs.

• The practice asked patients for feedback about the services they provided.

• There was no system in place to ensure that untoward events were analysed and used as a tool to prevent their reoccurrence.

• Systems to ensure the safe recruitment of staff were not robust, as essential pre-employment checks were not completed.

• Audit systems were not effective and action had not been taken to address identified shortfalls.

• The practice’s sharps handling procedures and protocols did not comply with the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.

• Information and evidence of some dental examinations and risk assessments was missing from patient dental care records.

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

• Ensure effective systems and processes are established to assess and monitor the service against the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and national guidance relevant to dental practice. This includes the recording and monitoring of significant events; ensuring appropriate medical emergency equipment is available, ensuring staff recruitment is effective and improving the quality of audits.

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

• Review the practice’s protocols for recording in the patients’ dental care records to ensure dental care records are maintained appropriately giving due regard to guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.

• Review the practice’s cleaning procedures to ensure that all areas are kept clean, hygienic and dust free.
• Review the practice’s responsibilities to the needs of people with a disability and the requirements of the Equality Act 2010.

During our inspection on 11 January 2013 people we spoke with made positive comments about their dental care and treatment. One person said, "I have no complaints at all. I am always treated with respect by the reception staff and by the dentist and nurse. They are all very considerate". Another person said, "I always see the same dentist, which is good. I have had continuity of care". They also said the dentist had, "Always explained things well, especially when having treatment”. Another person said, "I would give them 10 out of 10 and a gold star for service”.

Care and treatment records had neatly recorded and carefully retained in hand written form for each person. Records had been kept each time a person had attended the clinic, although it had not been recorded every time a person had been verbally asked about their medication and health.

Safeguarding policies to protect children and vulnerable adults and training of staff in these matters need improving to confirm what action the provider will take, should abuse be suspected, or alleged.

Cleanliness and infection prevention is managed so that staff are safe and competent and that people are safe from the risks and spread of healthcare associated infection.

The premises were kept clean, were brightly lit and had been well maintained. Suitable fire safety precautions had been implemented to ensure the premises and people were safe form the risk of fire.