We carried out an announced comprehensive inspection of this practice 17 September 2015. Breaches of legal requirements were found. After the comprehensive inspection, the practice wrote to us to say what they would do to meet legal requirements in relation to the breaches.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. 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 Buntingford Dental Care on our website at www.cqc.org.uk

Our findings were:

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

Buntingford Dental Care is a general dental practice in Buntingford, Hertfordshire. It offers NHS and private dental treatment to adults and children.

The premises consist of four treatment rooms, a waiting room adjacent to a reception area and a separate decontamination room.

The practice manager is in the process of applying to be 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.

Our key findings were:

• The practice had employed a new practice manager and was in the process of applying to become the registered manager.
• A system for recording and managing verbal and written complaints had been implemented.
• A number of risk assessments had been completed to highlight areas in the practice where safety could be improved.

• Infection control audits were carried out six monthly and highlighted any areas where action could be taken to improve.

We carried out an announced comprehensive inspection on 17 September 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 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 not 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.

We inspected the practice on 1 October 2014 in response to concerns that standards weren’t being met and asked the provider to make improvements regarding;

• Cleanliness and infection control,

• Safety and suitability of premises,

• Records.

We checked these areas as part of this comprehensive inspection and found these had been resolved.

Buntingford Dental Care is a general dental practice in Buntingford, Hertfordshire offering NHS and private dental treatment to adults and children.

The premises consist of four treatment rooms over two floors; a waiting room adjacent to the reception area and a separate decontamination room.

The staff at the practice consist of two dentists, a dental nurse, a trainee dental nurse and a receptionist. The practice employs the services of two part time dental hygienists who carry out preventative advice and treatment on prescription from the dentists. There is currently no practice manager employed; the registered manager no longer works at the practice. 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.

Our key findings were:

• There were effective systems in place for the management of medical emergencies.

• There were effective arrangements in place to meet the Control of Substances Hazardous to Health 2002 (COSHH) regulations.

• There were effective staff recruitment and selection procedures in place.

• Patients’ dental care records we reviewed provided a full and accurate account of the care and treatment they had received.

• We observed staff to be caring, friendly, reassuring and welcoming to patients.

• Staff were clear about the principles of confidentiality and understood how to keep patients’ information secure.

• There were insufficient numbers of staff available to effectively lead, manage and support patients’ and staff needs.

• Staff did not always receive such appropriate support and appraisal as is necessary to enable them to carry out the duties they are employed to perform.

• There was a lack of an effective system to assess, monitor and improve the quality and safety of the services provided.

• There was a lack of an effective system to assess, monitor and mitigate the risks relating to the health, safety and welfare of patients, staff and visitors.

• There was a lack of effective processes for acknowledging, recording, investigating and responding to complaints, concerns and suggestions made by patients.

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

• Ensure that the premises used by the service provider are safe to use for their intended purpose and are used in a safe way.

• Ensure that the equipment used by the service provider for providing care or treatment to a service user is safe for such use and is used in a safe way.

• Ensure there are sufficient numbers of staff available to effectively lead, manage and support patients’ and staff needs.

• Ensure staff receive such appropriate support and appraisal as is necessary to enable them to carry out the duties they are employed to perform.

• Establish an effective system to assess, monitor and improve the quality and safety of the services provided.

• Establish an effective system to assess, monitor and mitigate the risks relating to the health, safety and welfare of patients, staff and visitors.

• Establish an effective process for acknowledging, recording, investigating and responding to complaints, concerns and suggestions made by patients.

• Notify the Care Quality Commission that the registered manager has ceased to manage the regulated activities at the practice.

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:

• Establish a process for monitoring the referral of patients for dental treatment and specialist procedures to other healthcare professionals which ensures timely access to care and treatment.

• Establish an effective system to regularly undertake and monitor environmental cleaning.

• Follow manufacturer’s guidance when using ultrasonic cleaning baths to allow effective decontamination of dental instruments.

We inspected Buntingford Dental Care because we had received concerning information about the care provided at this practice.

We spoke with two patients who both gave very positive feedback about the care and treatment they had received. One patient told us, ‘’I have complete confidence in my dentist. They explain everything and make me feel relaxed and at ease.’’ They also told us that they were given time to consider the options available before they agreed to have treatment.

We found the staff polite and courteous and heard them speak to patients in a very pleasant and welcoming manner. We spoke with two dentists who confirmed to us that they checked changes to patients’ medical histories before any treatment commenced.

The practice had adequate equipment to support people in the event of a medical emergency.

We found that improvements were needed to infection control procedures and the process of decontaminating used dental instruments so these were carried out in accordance with guidance from the Department of Health.

Improvements were also needed to the way the practice managed the premises from which it operated.

We found that improvements were needed to the fire safety and cleaning arrangements.

While the practice had maintained electronic patient records for a number of years, we found the arrangements for the storage of previous paper records were unsatisfactory and needed improvement.