During our comprehensive inspection of this practice on 8 March 2016, we found a breach of legal requirements in relation to the Health and Social Care Act 2008. Following this inspection, the practice wrote to us to say what they would do to meet legal requirements in relation to regulation 12- Safe Care and Treatment.

We undertook this focused inspection to check that the provider had followed their improvement plan and to confirm that they now met legal requirements. This report only covers our findings in relation to this requirement. You can read the report from our previous comprehensive inspection, by selecting the 'all reports' link for Broad Street Dental Practice at www.cqc.org.uk

Are services Safe?

We found that this practice was providing safe care in accordance with the relevant regulations.

Key findings

• Overall, we found that adequate action had been taken to address the shortfalls identified at our previous inspection and the provider was now meeting the regulations.

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

• Review fire safety practices and ensure staff receive regular fire training and also undertake fire evacuation drills.

• Sign and date sharps’ bins when first used.
• Review storage for dangerous chemicals .

We carried out an announced comprehensive inspection on 8 March 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

Broad Street Dental Practice is located in the town of Whittlesey in Cambridgeshire. It provides a private dentistry service to adults and an NHS dental and orthodontic service to children up to the age of 18 or up to the age of 19 if in full time education. The practice is led by a partnership of two principal dentists who employ two part time dentists, two dental hygienists, three dental nurses and three receptionists. The practice opens from 8.30am until 5pm three days a week, has extended hours until 7.30pm on Wednesdays and closes at 4pm on Fridays. It also opens on Saturday mornings twice a month.

A dental partner is the 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.

We received feedback from 47 patients either in person or through CQC comments cards from patients who had visited the practice in the two weeks before our inspection. The cards were all very positive showing that patients valued the service they received. Patients said that staff were very welcoming, patient and helpful. They told us staff listened to them, involved them in decisions about their care and provided a service they valued.

Our key findings were:

• There was appropriate equipment for staff to undertake their duties, and equipment was well maintained.
• The practice had access to emergency equipment and this included an automated external defibrillator and medical oxygen. Emergency medicines were in line with the British National Formulary (BNF) guidance for medical emergencies in dental practice.
• 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 and its costs, benefits, and risks and were involved in making decisions about them.
• Patients were treated with dignity and respect and their confidentiality was maintained.
• The appointment system met the needs of patients and waiting times were kept to a minimum.
• Arrangements for staff training were in place although improvement was needed to identify their individual learning and development needs.
• An accident reporting process was in place although improvement was needed to the records made of any actions taken including any learning.
• A complaints process was in place and this was well managed. However, a process for identifying learning and any subsequent action was not in place.

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

• Ensure that action is taken to identify and manage any infection control risks. This must include regular infection control audits, the appropriate use of personal protective equipment, regular checks of the water temperatures and adequate control measures for any identified legionella risks.

You can see full details of the regulations not being met at the end of this report.

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

• Review the practice’s arrangements for receiving and responding to patient safety alerts, recalls and rapid response reports issued through the Central Alerting System (CAS), as well as from other relevant bodies such as, Public Health England (PHE).
• Review the practice’s system for recording, investigating and reviewing accidents, incidents or significant events with a view to preventing further occurrences, ensuring that improvements are made and sharing the learning appropriately.
• Review the actions taken following sharps handling injuries in line with the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.
• Review the systems used to record the checks completed of the emergency equipment and medicines.
• Review the practice’s protocols for the use of rubber dam for root canal treatment giving due regard to guidelines issued by the British Endodontic Society
• Review fire safety procedures at the premises and ensure that all staff are familiar with them.
• Review staff awareness of Gillick competency and ensure all staff are aware of their responsibilities.
• Review the checks used to validate the effectiveness of the ultra-sonic cleaning bath.
• Review and develop health and safety risk assessments and responsibilities in regards to the Control of Substance Hazardous to Health (COSHH) Regulations 2002 so that information is clear and staff understand how to minimise any associated risks.
• Review the appraisal process for staff to include the identification of their learning and development needs and any on-going assessment.
• Review the practice's recruitment procedures to ensure that a written policy is in place and ready to use when new staff are recruited.
• Review the practice’s audit protocols for radiography to help improve the quality of service. The practice should also check all audits have documented learning points and the resulting improvements can be demonstrated.
• Review its complaint handling procedures to include a process to identify and act upon learning from complaints raised.

People we spoke with confirmed that their consent was obtained before any procedure was started. They were able to change their decision about treatment options and this was respected.

All of the people we spoke with said they received treatment plans and dentists gave them clear information about their treatment options, the risks and benefits of each option.

They said that the surgery was always clean when they visited and they were all confident in the abilities of dentists and dental nurses.