We carried out an announced focused inspection on 27 October 2015. The reason for this inspection was to gain assurance that the practice had addressed the concerns identified in our inspection of the 10 June 2015. We found that, in June, the practice was not meeting Regulation 17 - Good Governance.

Our findings were:

Are services well-led?

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

The practice is an NHS funded family partnership situated in the centre of Clayton Brook in Chorley. There is one principal dentist and an associate dentist. The practice also employs a dental hygienist, two dental nurses, and two cadent dental nurses. The practice manager is also a qualified dental nurse but their main duty is to cover receptionist duties. A new role for the implementation and monitoring of governance processes had been put in place.

Our key findings were:

• The practice has implemented a system which recorded and analysed significant events and complaints and cascaded learning to staff.
• The practice had a structure and process in place to monitor staff training.
• The problems with clinical waste storage had been addressed.
• The practice had implemented a new leadership and governance structure.
• Short falls in the governance systems had been actioned.
• All practice policies and procedures had been reviewed. All procedures were generic and practice specific.
• A full audit of records relating to the employed staff had been conducted and gaps in information was being followed up.
• An approach for identifying and addressing concerns raised through audit had been put into place.
• A standard staff meeting template enabled communication about the quality and safety of services and what actions have been taken as a result of audits, concerns, complaints and compliments to be shared with staff.

We carried out an announced comprehensive inspection on 10 June 2015.

The practice is an NHS funded family partnership situated in the centre of Clayton Brook in Chorley. There are two partner dentists and an associate dentist. The practice also employs a dental hygienist, two dental nurses, and two cadet/apprentice dental nurses. The practice manager is also a qualified dental nurse but their main duty is to cover receptionist and administration duties.

The practice provides primary dental services to approximately 1,600 NHS patients with a small minority of private patients. The practice is open Monday to Friday 9.00am – 5.00pm and closes for an hour at lunchtime. There are occasional late evening and Saturday surgery hours available.

The dentist is the registered provider for the practice. 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 viewed 32 CQC comment cards that had been left for patients to complete, prior to our visit, about the services provided. All of the comment cards reflected positive comments about the staff and the services provided. Patients commented that the practice was clean and hygienic, they found the staff very friendly and approachable and they found the quality of the dentistry to be excellent. They said explanations were clear and made the dental experience as comfortable as possible.

The practice was providing care which was safe, effective, caring, and responsive in accordance with the relevant regulations. However we found that this practice was not always providing well led care in accordance with the relevant regulations.

Our key findings were:

• The practice did not have a system in place which recorded and analysed significant events and complaints and cascaded learning to staff.
• Staff had received safeguarding and whistleblowing 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 handle emergencies and appropriate medicines and life-saving equipment were readily available.
• Staff had undertaken training but some of this was out of date. There was no formal system in place to monitor training.
• Infection control procedures were in place and the practice followed published guidance however clinical waste storage was a concern.
• Patient’s care and treatment was planned and delivered in line with evidence based guidelines, 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 had some shortfalls in leadership, however staff felt involved and worked as a team.
• Governance systems were not effective. Although there was a range of clinical and non-clinical audits to monitor the quality of services, concerns identified had not been acted upon.
• Practice policies and procedures had not been reviewed periodically. Some procedures were generic and not practice specific.
• The practice sought feedback from patients about the services they provided.

We identified that regulation 17 was not being met and the provider must:

• Ensure that records relating to employed staff include information relevant to their recruitment.
• Ensure there is an effective approach for identifying where quality and/or safety is being compromised and steps are taken in response to issues. These include all audits and risk assessments undertaken within the practice.
• Establish systems to support communication about the quality and safety of services and what actions have been taken as a result of audits, concerns, complaints and compliments.
• Ensure that audit processes function well and have a positive impact in relation to quality governance, with clear evidence of actions to resolve concerns.
• Establish processes to actively seek the views of patients and should be able to provide evidence of how they have taken these views into account in relation to decisions.

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 systems are in place which monitor that all staff members receive appropriate support, training and supervision necessary for them to carry out their duties.
• Ensure that all policies and procedures for the practice are reviewed and meet the needs staff and are practice specific.
• Undertake an assessment of all staff as to whether a Disclosure and Barring Service Check was necessary in relation to their role in the practice.
• The provider should ensure that waste management systems are in line with the statutory duty of care where it is required that the producers of clinical waste were responsible for preventing its escape. They should take all reasonable measures to ensure that waste was dealt with appropriately from the point of production to the point of disposal.
• Ensure that all equipment checks are performed as required and records kept of these.

We carried out a visit to the practice but did not get the opportunity to speak with any patients. However, we looked at patients’ responses to a recent satisfaction surrey that had been carried out. We noted that the responses were very positive. Comments included;

’The practice is much improved and modernised.’

‘The practice is very clean.’

‘You get a good level of information. The dentist listens and takes time to explain things.’

‘The most positive thing is the attitude and professionalism of the dentist and staff.’

‘The dentist understands my nervousness.’