We carried out an announced comprehensive inspection at Buckle and McGrath – Hilltop Court on 14 October 2015 and at this time breaches of a legal requirement were found. After the comprehensive inspection the practice wrote to us and told us that they would take action to meet the following legal requirements set out in the Health and Social Care Act (HSCA) 2008:

Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2010, Fit and proper persons employed.

On 14 April 2016 we carried out a focused review of this service under section 60 of the Health and Social care Act 2008 as part of our regulatory functions. The review was carried out to check whether the provider had completed the improvements needed and identified during the comprehensive review on 14 October 2015. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Buckle and McGrath – Hilltop Court on our website at cqc.org.uk

The findings of this review were as follows:

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

• The practice had addressed the issues identified during the previous inspection.
• Its recruitment policy and procedures were suitable and recruitment arrangements were in line with Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Necessary employment checks were in place for all staff and the required specified information in respect of persons working at the practice was held.

We carried out an announced comprehensive inspection on 14 October 2015 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 not 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 providing well-led care in accordance with the relevant regulations.

Background

The practice is situated in the village of Thornton Hough, Wirral. The practice has one principal dentist, two associate dentists, a dental hygienist, a dental therapist, a practice manager, two qualified dental nurses and two trainee dental nurses. The practice provides primary dental services to predominately private patients. The practice is open Monday to Thursday 8.30am – 6pm and Friday 8.30am – 5pm.

The principal dentist is the registered provider. A registered provider is registered with the Care Quality Commission to manage the service. Registered providers 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 viewed two CQC comment cards that had been left by patients who completed them prior to our visit and spoke to three patients on the day of inspection, about the services provided. The comment cards seen and patients spoken to reflected positive comments about the staff and the services provided. Patients commented that the practice appeared very clean; they found the staff very caring and friendly. They had trust and confidence in the dental treatments and said explanations were clear and understandable. Emergency appointments were available on the same day and appointments usually ran on time.

Our key findings were:

• The practice recorded and analysed significant events and complaints and cascaded learning to staff when they occurred.
• Staff had received safeguarding training and knew the processes to follow to raise any concerns.
• There were sufficient numbers of suitably qualified staff to meet the needs of patients.
• Staff had been trained to deal with medical emergencies and emergency medicines and emergency equipment were available.
• Infection control procedures were in place.
• Patients’ care and treatment was planned and delivered in line with evidence based guidelines, best practice and current legislation.
• Patients received clear explanations about their proposed treatment, costs, benefits and risks and were involved in making decisions about it.
• Patients were treated with dignity and respect and confidentiality was maintained.

• The appointment system met the needs of patients and waiting times were kept to a minimum.
• The practice staff felt involved and worked as a team.

• The practice sought feedback from staff and patients about the services they provided.

We identified a regulation that was not being met and the provider must:

• Ensure its recruitment policy and procedures are suitable and 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 working at the practice is held.

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

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

• That patient safety and other relevant alerts and guidance is followed and actions taken documented.
• The Hepatitis immunisation status of staff is recorded and checked.

We invited patients visiting the service during our visit to talk about their experiences although no-one wished to speak with us. We were able to gain comments from patient feedback forms. These were positive and included comments such as:

"The service and care is excellent"

"They are excellent and professional"

"I would recommend this service"

"I am happy with the treatment"

"They always listen to the requirements of customers"