We carried out a follow- up inspection of this service on 19 July 2017.

We had undertaken an unannounced comprehensive inspection of this service on 18 July 2016 as part of our regulatory functions where breach of legal requirements was found.

After the comprehensive inspection, the practice wrote to us to say what they would do to meet the legal requirements in relation to the breach. This report only covers our findings in relation to those requirements.

We reviewed the practice against three of the five questions we ask about services: is the service safe, responsive and well-led?

We revisited the surgery as part of this review and checked whether they had followed their action plan.

You can read the report from our last comprehensive inspection by selecting the 'all reports' link for Clevedon Dental Care on our website at www.cqc.org.uk.

We carried out an announced comprehensive inspection on 18 July 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 this practice was not providing safe care in accordance with the relevant regulations.

Are services effective?

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

Are services caring?

We found this practice was providing caring services in accordance with the relevant regulations.

Are services responsive?

We found this practice was not providing responsive care in accordance with the relevant regulations.

Are services well-led?

We found this practice was not providing well-led care in accordance with the relevant regulations.

Background

Clevedon Dental Care is a community based practice located in a residential area. A local bus service operates in the area and there is parking in a nearby public car park. The practice provides routine care for patients of all ages under NHS regulations and private contract. The services provided and the fees are displayed on the practice website and in information leaflets available in the practice for patients. It has three surgeries with one on the ground and two on the first floor; a waiting are on each floor and access for patients with limited mobility and pushchairs. Facilities offered include wheelchair access, multilingual staff, large waiting area and children’s area.

At the time of the inspection there was a practice manager in post, however the practice did not have a 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.

The practice is open Monday to Friday, 09:00am - 1:00pm and 2:00pm - 5:30pm. The practice is closed at weekends. For emergency and out of hour’s assistance contact information is available at the practice and from the telephone answering service. The information was not displayed on the practice website.

We reviewed 14 CQC comment cards that had been left for patients to complete, prior to our visit, about the services provided. In addition we spoke with four patients on the day of our inspection. Feedback from patients was positive about the care they received from the practice, however they were not always able to get an appointment or appointments were cancelled at short notice. A number of patients reported cancelled appointments at short notice and lack of continuity with a different dentist at every visit.

Patients commented staff put them at ease, listened to their concerns and provided a service in which they had confidence in the dental care provided.

Our key findings were:

• There were some systems in place to help ensure the safety of staff and patients however they were not operated effectively. These systems included safeguarding children and adults from abuse and maintaining the required standards of infection prevention and control and responding to medical emergencies. However not all staff had undertaken training in these areas.

• Effective leadership was not provided by the practice manager or clinicians and they were not appropriately supported by the provider.

• The practice had limited clinical governance and risk management processes in place including health and safety and the management of medical emergencies. These limited systems were not managed effectively; for example action had not been taken to mitigate identified risks in relation to infection control and the management of accidents.

• The practice had some systems to monitor the quality of the service through audit; however they did not act on the results to improve service quality.

• Premises were not well maintained and door frames, stairs and skirting boards required painting. There was no documentary evidence of planned maintenance to address these areas.

• A tour of the building confirmed that cleaning and infection control systems were in place however the disposal of waste was not being well managed. The treatment rooms were organised and equipped, with good light and ventilation.

• There were systems in place to check all equipment had been serviced regularly, including the air compressor, autoclave, fire extinguishers, oxygen cylinder and the X-ray equipment.

• There were not always sufficient numbers of suitably qualified staff who maintained the necessary skills and competence to support the needs of patients. For example a lack of employed dentists at the practice and three trainee dental nurses who were not well supported.

• A member of staff working with patients had not received a hepatitis B immunisation and there was no risk assessment in place to protect patients or them.

• Staff were kind, caring, competent and put patients at their ease.

• Staff had not received appropriate support, training, professional development, supervision and appraisal as is necessary to enable them to carry out the duties they are employed to carry out.

• We found the dentist regularly assessed each patient’s gum health and took X-rays at appropriate intervals.

• Patients commented they felt involved in their treatment and that it was fully explained to them.

• Common themes from the 14 CQC comment cards were patients felt the staff were kind and caring and they received good treatment. However they reported concern about the poor service availability with cancelled appointments; lack of access to emergency treatment; long waiting times for appointments and lack of continuity with different dentists at every visit.

• Information about how to complain was available and easy to understand.

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

• Ensure that where incidents have taken place they are appropriately dealt with, fully documented and reported upon. Learning points are identified reported upon and fed back to staff take into their practice.
• Ensure that staff do not commence work until either immunisation status against hepatitis B and other required immunisations is confirmed or a risk assessment completed to mitigate risks.
• Ensure policies, procedures and risk assessments are up to date, contain local relevant information and are fit for purpose.
• Ensure an effective system is operated for collating the records of training, learning and development needs of staff members. This to ensure all training needs are identified for individual staff members as part of a staff appraisal system
• Ensure an effective system for running the dental practice to meet patients’ needs.