We undertook a focused inspection of the Compass Clinic on 18 March 2019. This inspection was carried out to review in detail the actions taken by the registered provider to improve the quality of care and to confirm that the practice was now meeting legal requirements.

The inspection was led by a CQC inspector who was supported by a dental specialist advisor.

We undertook a comprehensive inspection of the practice on 24 May 2019 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We found the registered provider was not providing well-led care and was in breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can read our report of that inspection by selecting the 'all reports' link for Compass Clinic on our website www.cqc.org.uk.

When one or more of the five questions are not met we require the service to make improvements and send us an action plan. We then inspect again after a reasonable interval, focusing on the areas where improvement was required.

As part of this inspection we asked:

• Is it well-led?

Background

The Compass Clinic provides both NHS and private treatment to patients of all ages. The practice opens on Monday to Friday, from 9am to 5pm. The practice is one of two owned by the company, and has a sister practice a few miles away. The practice is based in the local community hospital and shares many of its facilities.

There is level access for people who use wheelchairs and those with pushchairs.

The permanent dental team includes one dentist, one dental nurse a practice manager and reception staff. A hygienist works two afternoons a month. The practice has two treatment rooms.

As a condition of registration, the practice must have a person registered with the Care Quality Commission as the registered manager. Registered managers 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 registered manager is the company’s chief executive officer, who also acts as the practice manager.

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

Our findings were:

Are services Well-led?

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

Key findings

The provider had made satisfactory improvements to put right many of the shortfalls we found at our inspection on 24 May 2018. However, there remained areas where the provider could make improvements. They should:

• Review the practice's recruitment procedures to ensure that appropriate DBS checks are completed prior to new staff commencing employment at the practice.

• Review the availability of an interpreter service for patients who do not speak English as their first language.

• Review the practice's staffing levels and ensure the practice can provide routine appointments in a timely manner to its patients.

We carried out this announced inspection on 23 May 2018 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We planned the inspection to check whether the registered provider was meeting the legal requirements in the Health and Social Care Act 2008 and associated regulations. We had also received a number of complaints about the practice. 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 this practice was 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

The Compass Clinic provides both NHS and private treatment to patients of all ages. The practice opens on Monday to Friday, from 9 am to 5pm. The practice is one of two owned by the company, and is based in the local community hospital and shares many of its facilities.

There is level access for people who use wheelchairs and those with pushchairs.

The permanent dental team includes one dentist, one dental nurse and one reception staff. Due to recruitment difficulties, locum staff are also employed. A hygienist works two afternoons a month. The practice has two treatment rooms.

As a condition of registration, the practice must have a person registered with the Care Quality Commission as the registered manager. Registered managers 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 registered manager is the company’s chief executive officer, who also acts as the practice manager.

On the day of inspection, we collected seven CQC comment cards filled in by patients and spoke with two other patients.

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

Our key findings were:

• The practice had suitable safeguarding processes and staff knew their responsibilities for protecting adults and children.

• Patients’ needs were assessed and care was planned and delivered in line with current best practice guidance from the National Institute for Health and Care Excellence (NICE) and other published guidance.

• The practice provided preventive care and support to patients to ensure better oral health.

• Patients received their care and treatment from staff who enjoyed their work.

• There was no system in place to ensure that untoward events were analysed and used as a tool to prevent their reoccurrence.

• Systems to ensure the safe recruitment of staff were not robust, as essential pre-employment checks had not been completed.

• The provider had failed to address issues we had raised in our previous inspection such as the state of surgery flooring and confidentiality between the two surgeries.

• Complaints were not recorded adequately and there was no evidence to show they were used to improve the service.

• We received a number of complaints from patients about the practice who expressed concerns about the turnover of dentists and the cancellation of their appointments.

• There was no portable hearing loop to assist those who wore hearing aids. Information about the practice and patients’ medical histories was not available in any other languages, or formats such as large print. The practice did have access to translation services, but this was not well advertised to patients.

We identified regulations the provider was not meeting. They must:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

• Establish and operate an accessible system for identifying, receiving, recording and responding to patients’ complaints

Full details of the regulations the provider was not meeting are at the end of this report.

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

• Review the management of sharps procedures and ensure the practice is in compliance with the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.

• Review the practice’s protocols for the use of rubber dam for root canal treatment taking into account guidelines issued by the British Endodontic Society.

• Review protocols for the use of X-ray equipment taking into account Guidance Notes for Dental Practitioners on the Safe Use of X-ray Equipment.

We carried out an announced comprehensive inspection on 14 June 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 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 providing responsive care in accordance with the relevant regulations.

Are services well-led?

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

The practice has one full time dentist, one part time dentist, two dental nurses, a receptionist and a practice manager who also works at another location. The practice provides primary dental services to NHS and private patients and opens on Monday to Friday between 9am and 5pm.

The practice manager 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.

We spoke with patients and reviewed 22 CQC comment cards which had been completed by patients prior to the inspection. All the comments reflected positively on the staff and the services provided. Patients commented that the practice was clean and hygienic, they found it easy to book an appointment and they found the quality of the dentistry to be excellent. They said explanations were clear and that the staff were kind, caring and reassuring.

Our key findings were:

• The practice recorded and analysed significant events and complaints and cascaded learning to staff.
• Where mistakes had been made there was a policy that patients were notified about the outcome of any investigation and given a suitable apology.
• 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; appropriate medicines and life-saving equipment were readily available.
• Infection control procedures were robust and the practice followed published guidance on the majority of occasions, however, there were minor areas for improvement.
• Patient 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.
• There was an effective complaints system and the practice was open and transparent with patients if a mistake had been made.
• The practice sought feedback from staff and patients about the services they provided.
• Staff were well supported by the leadership of the practice in order to carry out their roles effectively.

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

• Ensure that patient alerts are disseminated effectively to staff and that circulation is recorded.
• Ensure the sterilisation equipment is used in accordance with manufacturers instructions and national guidance .
• Ensure the practice policy on completing DBS checks is followed.

During our visit on the morning of 5 December 2011 there was no clinic. We checked records, toured the premises and spoke with staff. We were unable to obtain people’s views of the service.