We carried out this announced inspection on 21 September 2017 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We carried out the inspection to follow up concerns we originally identified during a comprehensive inspection at this practice on 11/12 November 2015 under the Health and Social Care Act 2008 and associated regulations. The inspection was led by a CQC inspector who was supported by a specialist dental adviser.

To get to the heart of patients’ experiences of care and treatment, we always ask the following five questions:

• Is it safe?

• Is it effective?

• Is it caring?

• Is it responsive to people’s needs?

• Is it well-led?

These questions form the framework for the areas we look at during the inspection.

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 providing well-led care in accordance with the relevant regulations.

Background

Clent Dental Care is located in a residential area in Hagley and provides private treatment to patients of all ages.

There is level access for people who use wheelchairs and pushchairs. The practice is in a renovated residential bungalow with all rooms on one level consisting of a reception area with a waiting room, two patient toilets one of which is wheelchair accessible, two dental treatment rooms, a staff room / kitchen, a practice management office and a decontamination room for the cleaning, sterilising and packing of dental instruments. There is also a beautician’s room which is currently not in use and was not reviewed as part of this inspection. Car parking spaces, including spaces for patients who are blue badge holders, are available directly outside the practice in their dedicated car park.

The dental team includes the principal dentist, two dental nurses, one dental hygienist, one receptionist and the practice manager. The practice has two treatment rooms.

The practice is owned by an individual who is the principal dentist there. They have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run.

On the day of inspection we collected 29 CQC comment cards filled in by patients. This information gave us a positive view of the practice.

During the inspection we spoke with the principal dentist, two dental nurses and the practice manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday: 9am – 7pm

Tuesday: by appointment only

Wednesday: 9am to 7pm

Thursday: 9am to 5pm

Friday: by appointment only

Our key findings were:

• The practice was mostly clean and well maintained; there was scope to improve the environmental cleaning of high areas in the dental treatment rooms and to replace a dental unit with a broken frame which impeded the unit being able to be cleaned thoroughly.

• The practice had infection control procedures and a policy however these were not always fully adhered to by all staff members.

• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available with the exception of one medicine that had been incorrectly disposed of; this was re-ordered on the day of our inspection.
• The practice had systems to help them manage risk.
• The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• The practice had thorough staff recruitment procedures.
• The clinical staff provided patients’ care and treatment in line with current guidelines.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• The appointment system met patients’ needs.
• The practice had effective leadership. Staff felt involved and supported and worked well as a team.
• The practice asked staff and patients for feedback about the services they provided.
• The practice dealt with complaints positively and efficiently.

There were areas where the provider could make improvements. They should:

• Review the practice’s systems in place for environmental cleaning taking into account current national guidelines.
• Review the practice’s infection control procedures and protocols to take into account guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices and have regard to The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance’.
• Review the practice’s protocols for the use of rubber dam for root canal treatment.
• Review the practice's protocols for completion of dental records giving due regard to guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.

During this inspection we spoke with the practice manager, three dental nurses and a receptionist. We also spoke on the telephone with six people who used the practice.

People who used the practice were very complimentary about the care and treatment they received. One person said the practice was: “Wonderful, it’s the best I have been to”. People told us they were given information about their treatment and the dentist: “Explained everything to me thoroughly”. There was medication and oxygen available for medical emergencies and staff had been trained to know what to do if a person became unwell at the practice.

The practice was clean and hygienic. People we spoke with confirmed that this was their experience too. There were suitable arrangements for the cleaning, sterilising and storing of instruments so that people were not placed at risk of infection.

The dental team were qualified and maintained their continuous professional development as required by the General Dental Council so that they knew how to support people.

The provider had systems of audits in place to enable them to monitor the quality of the service provided. This made sure that people received appropriate care and treatment.

People were asked for their views about the practice and these were listened to. This made sure that people felt involved in their care and treatment.

We carried out an announced comprehensive inspection on 11 and 12 November 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 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

Clent Dental Care has one dentist who works part time, three dental nurses, a dental hygienist and a practice manager. One of the dental nurses is qualified and registered with the General Dental Council (GDC), one is a trainee and the other is completing training and will undertake a ‘back to work’ course to enable them to register with the GDC. Until registered with the GDC this member of staff is working on the reception.

The practice’s opening hours are 9am to 7pm on Mondays and Thursdays and 9am to 5pm on Fridays. The practice is closed on Tuesday and Wednesday. Emergency on call arrangements are in place when the practice is closed. Telephone calls are diverted to a member of staff or the practice manager who pass details on the dentist for advice or to arrange treatment.

Clent Dental Care provides private treatment for both adults and children. The practice is situated in a converted residential property. The practice had two dental treatment rooms; both of which are on the ground floor; one of which is used by the dentist and the other by the dental hygienist. There is a separate decontamination room for cleaning, sterilising and packing dental instruments. There is also a reception and waiting area and a beautician’s room which was not reviewed as part of this inspection.

The practice owner 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.

Before the inspection we sent Care Quality Commission comment cards to the practice for patients to complete to tell us about their experience of the practice. We received feedback from 28 patients. These provided a positive view of the services the practice provides. All of the patients commented that the quality of care was excellent.

Our key findings were:

• Systems were in place to record accidents and significant events so that staff could learn from these.
• There were sufficient numbers of suitably qualified staff to meet the needs of patients.
• Staff knew how to treat patients in a medical emergency, although the emergency oxygen had expired and was therefore not fit for use. A new emergency oxygen cylinder was purchased during the inspection.
• Staff were following infection control procedures regarding the decontamination of dental equipment and the practice was visibly clean and clutter free, however infection control audits were not undertaken on a six monthly basis.
• Patients told us they were treated with care, respect and dignity. Patients commented they felt involved in their treatment and said that it was fully explained to them.
• Patients’ care and treatment was planned and delivered in line with evidence based guidelines and current legislation.
• There were clearly defined leadership roles within the practice and staff told us they felt supported and comfortable to raise concerns or make suggestions.
• Patients were able to make routine and emergency appointments when needed. The appointment system met the needs of patients and waiting times were kept to a minimum.
• New standardised policies had been put in place and the practice manager was in the process of adapting these to meet the needs of the practice. Further work was to be completed to ensure sufficient information was available on these policies to guide staff.
• Staff reported that they enjoyed their work, felt supported and worked well as a team.

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

• Ensure an effective system is establishedto assess, monitor and mitigate the various risks arising from undertaking of the regulated activities. This should include systems to maintain and monitor emergency medicine and equipment, first aid packs, infection prevention and control and fire systems including risk assessments. Where appropriate X-ray signage must be in place.
• Ensure that an accurate, complete and contemporaneous record is maintained in respect of each patient, including a record of the decisions taken in relation to the care and treatment provided.
• Ensure all newly implemented policies and procedures contain a date of implementation and review and that these are audited in 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:

• Undertake reviews and audits of consent and provide consent records that contain full details of conversations held.
• Review the training, learning and development needs of individual staff members at appropriate intervals.
• Develop and implement policies to guide staff regarding recruitment of staff.
• Develop systems for obtaining, analysing and acting upon feedback from patients.