We carried out a focused inspection of Bishopsworth Dental Surgery on 11 October 2017.

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

We carried out the inspection to follow up concerns we originally identified during a comprehensive inspection at this practice on 19 December 2016 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 areas 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 Good Governance 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 Bishopsworth Dental Surgery on our website www.cqc.org.uk.

We also reviewed the key questions of safe as we had made recommendations for the provider relating to these key questions. 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 19 December 2016.

We carried out an announced comprehensive inspection on 19 December 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 not providing well-led care in accordance with the relevant regulations.

Background

Bishopsworth Dental Practice is a dental practice providing NHS and private treatment for both adults and children. The practice is based in two former terraced residential properties, located on a busy through road in Bishopsworth, an area situated outside the city of Bristol. The practice is undergoing renovations and improvements.

The practice has four dental treatment rooms, one of which is based on the ground floor and a separate decontamination room used for cleaning, sterilising and packing dental instruments. The ground floor is accessible to wheelchair users, prams and patients with limited mobility.

The practice employs three dentists, two dental therapists, two dental nurses, three trainee dental nurses, two receptionists and a practice manager.

The practice’s opening hours were between 8:30 am and 5pm on Monday, Wednesday, Thursday and Friday, and Tuesday 8:30am and 6pm and Saturday 9am and 1pm. There are arrangements in place to ensure patients receive urgent medical assistance when the practice is closed. This was provided by an out-of-hours service. These arrangements were displayed in the practice and on a telephone answering service.

At the time of the inspection there was a practice manager in post, however the practice did not have a registered manager. 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.

The inspection took place over one day and was carried out by a CQC lead inspector, CQC inspector and specialist dental advisor.

We obtained the views of three patients on the day of our inspection and all were positive and supportive of the practice We also received 11 feedback cards which corroborated with the patient feedback on the day of inspection. All 14 patients were positive about the care they received from the practice. They were complimentary about the friendly, professional and caring attitude of the dental staff and the dental treatment they had received.

Our key findings were:

• We found that the practice ethos was to provide patient centred dental care in a relaxed and friendly environment.
• Staff had been trained to handle emergencies and appropriate medicines and life-saving equipment were readily available in accordance with current guidelines.
• The dental treatment rooms appeared clean and well maintained although some thoroughfares through the practice were dusty.
• There was appropriate equipment for staff to undertake their duties, and equipment was properly maintained.
• Infection control procedures generally followed published guidance although improvements could be made to streamline the process. For example the location of storage units and disinfection equipment inhibited the dirty to clean flow of instruments.
• The practice had identified a safeguarding lead professional and there were effective processes in place for safeguarding adults and children living in vulnerable circumstances.
• There was a process in place for reporting and shared learning when untoward incidents occurred in the practice.
• Dentists provided dental care in accordance with current professional and National Institute for Care Excellence (NICE) guidelines.
• The service was aware of the needs of the local population and took these into account in how the practice was run.
• Patients could access urgent treatment and emergency care when required.
• Staff did receive mandatory training, for example first aid and cardio pulmonary resuscitation (CPR). However there was no appraisal system in place to ensure the training, learning and development needs of individual staff members.
• Staff we spoke with felt well supported by the principal dentist and the practice manager and were committed to providing a quality service to their patients.
• Information from 11 completed Care Quality Commission (CQC) comment cards gave us a positive picture of a friendly, caring, professional and high quality service.
• The practice had some clinical governance and risk management structures in place, but we observed several shortfalls in systems and processes. For example there was no legionella risk assessment, annual infection control statement, fire risk assessment, safer sharps assessment or mains electrical testing.

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

• Ensure the practice’s sharps handling procedures and protocols are in compliance with the Health and Safety (sharp instruments in Healthcare) Regulations 2013
• Ensure that the practice undertakes a fire safety risk assessment in compliance with the requirements of the Regulatory Reform (Fire Safety) Order 2005.
• Ensure that a practice mains wiring assessment is carried out in compliance with the Electricity at Work Regulations 1989 and the 16th Edition I.E.E. regulations (BS BS 7671).
• Ensure that the practice undertakes a legionella risk assessment and implements the required actions giving due regard to guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices and the Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance.
• Ensure the practice's recruitment policy and procedures are suitable and the recruitment arrangements are in line with Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 to ensure necessary employment checks are in place for all staff and the required specified information in respect of persons employed by the practice is held.
• Ensure the training, learning and development needs of staff members are reviewed at appropriate intervals and an effective process is established for the on-going assessment and supervision of all staff employed.

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

• Review the protocols and procedures for use of X-ray equipment giving due regard to guidance notes on the Safe use of X-ray Equipment.

• Review and develop strategies for formalising the capture and response to patient feedback.
• Review the provision of a practice annual infection control statement in line with guidance provided by the Health and Social Care Act 2008: Code of practice on prevention and control of infection and its related guidance.
• Review the provision of cleaning in the practice in line with the guidance issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices and the Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance