We undertook a focused inspection of Bearwood Dental Care on 8 May 2019. This inspection was carried out to review in detail the actions taken by the registered provider to improve the quality of care and to confirm that the practice was now meeting legal requirements.

The inspection was led by a CQC inspector who was supported by a specialist dental adviser.

We undertook a comprehensive inspection of Bearwood Dental Care on 14 January 2019 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We found the registered provider was not providing well led care and was in breach of regulation 12 and 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 Bearwood Dental Care on our website www.cqc.org.uk.

As part of this inspection we asked:

• Is it well-led?

When one or more of the five questions are not met we require the service to make improvements and send us an action plan (requirement notice only). We then inspect again after a reasonable interval, focusing on the area(s) where improvement was required.

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 in relation to the regulatory breaches we found at our inspection on 14 January 2019.

Background

Bearwood Dental Care is in Smethwick and provides private treatment to adults and children.

There is ramped access for people who use wheelchairs and those with pushchairs. Two car parking spaces are available at the front of the practice and parking is also available on local side roads.

The dental team includes two dentists, three trainee dental nurses, one qualified dental nurse who is also the practice manager and one dental hygiene therapist. The practice has two treatment rooms.

The practice is owned by an individual who no longer undertakes any clinical work at the practice. Providers who are individuals and are not in day-to-day charge of carrying on the regulated activity must have a registered manager in respect of the regulated activities carried on at each location. At the time of inspection, there was no registered manager in post as required as a condition of registration. A registered manager is legally responsible for the delivery of services for which the practice is registered. The provider was reviewing registration conditions to ensure the regulated activities at Bearwood Dental Care are managed by an individual who is registered as a manager.

During the inspection, we spoke with one dental nurse and the dental hygiene therapist and we looked at practice policies and procedures and other records about how the service is managed.

The practice is open: Monday and Tuesday 9.30am to 8pm, Wednesday to Friday 9.30am to 5pm.

Our key findings were:

• Three yearly assessments of X-ray machinery had taken place as appropriate and documentation to demonstrate this, was available. Local rules were fully completed.

• The provider had purchased a new blood pressure monitor in May 2019.

• The provider had amended dispensing labels for antibiotics and appropriate dispensing information was recorded on these labels.

• Discussions had taken place with staff regarding the current guidance on antibiotic prescribing.

• Systems had been implemented regarding the assessment of patients with presumed sepsis in line with National institute of Health and Care Excellence guidance. Sepsis management had been discussed at a clinical meeting.

• Infection prevention and control audits were scheduled to take place on a six-monthly basis. The provider had completed an audit regarding sedation. Action plans were available from audits undertaken.

• The provider had documentation to demonstrate that all clinical staff had immunity against vaccine preventable infectious diseases.

• The provider was reviewing registration conditions to ensure the regulated activities at Bearwood Dental Care are managed by an individual who is registered as a manager.

• Systems had been put in place for checking and monitoring equipment and ensuring that all equipment was well maintained.

• Staff had completed training regarding the requirements of the Mental Capacity Act 2005. This had been discussed at a staff meeting in February 2019.

• The provider had reviewed the practice's current performance review systems and implemented a new process for the on-going assessment and supervision of all staff.

• The provider had reviewed the practice's protocols for completion of dental care records taking into account the guidance provided by the Faculty of General Dental Practice.

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

• Review the providers registration conditions to ensure the regulated activities at Bearwood Dental Care are managed by an individual who is registered as a manager.

We carried out this announced inspection on 14 January 2019 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.

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

Bearwood Dental Care is in Smethwick and provides private treatment to adults and children.

There is ramped access for people who use wheelchairs and those with pushchairs. Two car parking spaces are available at the front of the practice and parking is also available on local side roads.

The dental team includes two dentists, three trainee dental nurses, one qualified dental nurse – (the practice manager) and one dental hygiene therapist. The practice has two treatment rooms.

The practice is owned by an individual who no longer undertakes any clinical work at the practice. Providers who are individuals who will not be in day-to-day charge of carrying on the regulated activity must have a registered manager in respect of the regulated activities carried on at each location. At the time of inspection there was no registered manager in post as required as a condition of registration. A registered manager is legally responsible for the delivery of services for which the practice is registered

On the day of inspection, we received feedback from 12 patients.

During the inspection we spoke with two dentists, (including the principal dentist) two dental nurses, one dental hygiene therapist, and the practice manager. We looked at practice policies and procedures and other records about how the service is managed. The registered provider attended the practice at the start of the inspection to introduce themselves to the inspection team.

The practice is open: Monday and Tuesday 9.30am to 8pm, Wednesday to Friday 9.30am to 5pm.

Our key findings were:

• The practice appeared clean and well maintained.
• The provider had infection control procedures which reflected published guidance. Staff were not always working in accordance with these.
• Staff knew how to deal with emergencies. The majority of appropriate medicines and life-saving equipment were available. Missing items were purchased on the day of inspection.
• The practice had systems to help them manage risk to patients and staff although improvements were required.
• Improvements were required with the servicing and maintenance of X-ray equipment. The provider had not registered correctly with the Health and Safety Executive.
• The provider had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
• The provider had staff recruitment procedures. The practice did not have proof that two staff were adequality protected against the risk of hepatitis B and there was no risk assessment in place regarding this.
• The clinical staff provided patients’ care and treatment in line with current guidelines.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• Staff were providing preventive care and supporting patients to ensure better oral health.
• The appointment system took account of patients’ needs. The practice provided extended opening hours two days per week and were accommodating to patients’ needs at other times.
• Staff worked well as a team.
• The provider asked patients for feedback about the services they provided.
• The provider had systems in place to deal with complaints positively and efficiently.

We identified regulations the provider was not complying with. They must:

• Ensure care and treatment is provided in a safe way to patients.

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

Full details of the regulation the provider is not meeting are at the end of this report.

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

• Review the providers registration conditions to ensure the regulated activities at Bearwood Dental Care are managed by an individual who is registered as a manager.

• Review the practice's systems for checking and monitoring equipment taking into account relevant guidance and ensure that all equipment is well maintained. In particular implement systems to monitor the practice’s autoclave to ensure that it is working within the correct parameters. Implement systems to ensure that the practice’s emergency lighting and equipment used to monitor blood pressure of patients who were undergoing sedation is subject to regular servicing and maintenance.

• Review staff awareness of the requirements of the Mental Capacity Act 2005 and ensure all staff are aware of their responsibilities under the Act as it relates to their role.

• Review the practice's current performance review systems and have an effective process established for the on-going assessment and supervision of all staff.

• Review the practice's protocols for completion of dental care records taking into account the guidance provided by the Faculty of General Dental Practice.