We undertook a focused inspection of Crescent Dental Care on 20 December 2018.

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 remotely by a specialist dental adviser.

We undertook a comprehensive inspection of Crescent Dental Care on 28 August 2018 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 Crescent Dental Care on our website www.cqc.org.uk.

As part of this inspection we asked:

• Is the practice well-led?

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 area where improvement was required.

Our findings were:

Are services well-led?

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

The provider had made improvements in relation to the regulatory breach we found at our inspection on 28 August 2018.

Background

Crescent Dental Care is in Dunston, Tyne and Wear and provides NHS and private treatment to adults and children.

There is step-free access to the practice and on-street car parking is available nearby. The dental practice is combined with a wellness centre providing chiropody, physiotherapy and holistic care.

The dental team includes the principal dentist, two associate dentists, four dental nurses (two of whom are trainees), two dental hygiene therapists and a practice manager. The dental nurses also carry out reception duties. The practice has three treatment rooms all situated on the ground floor.

The practice is owned by a company and as a condition of registration 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 at Crescent Dental Care is the principal dentist.

We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday, Tuesday, Wednesday, Thursday 8.30am to 6.30pm.

Friday 8.30am to 4.30pm

Saturday 9am to 12.30pm.

Our key findings were:

• The practice had improved their systems to help them manage risk.
• The practice had effective leadership.
• A culture of continuous improvement was evident.

• Staff knew how to deal with emergencies and appropriate medicines and life-saving equipment were available.
• The provider undertook risk assessments for lone working staff and for staff whose immune status to the Hepatitis B vaccine was unknown.
• Safety alerts were received for medical drugs and equipment.
• The provider undertook thorough staff recruitment procedures for all staff employed.
• Clinical staff provided patients’ care and treatment in line with current guidelines
• The practice had closed-circuit television on the premises; a policy and data protection impact assessment had been created.
• The provider had carried out a disability access assessment of the premises and they had met the needs of those who had hearing or sight problems.
• Staff were using translation services when required.
• Staff training was monitored; this process was reviewed to be more effective.

We carried out this announced inspection on 28 August 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. 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 not providing well-led care in accordance with the relevant regulations.

Background

Crescent Dental Care is in Dunston, Tyne and Wear and provides NHS and private treatment to adults and children.

There is step-free access to the practice and on-street car parking is available nearby. The dental practice is combined with a wellness centre providing chiropody, physiotherapy and holistic care.

The dental team includes the principal dentist, two associate dentists, four dental nurses (two of whom are trainees), two dental hygiene therapists and a practice manager. The dental nurses also carry out reception duties. The practice has three treatment rooms all situated on the ground floor.

The practice is owned by a company and as a condition of registration 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 at Crescent Dental Care is the principal dentist.

On the day of inspection, we collected 36 CQC comment cards filled in by patients.

During the inspection we spoke with two dentists, four dental nurses, a dental hygiene therapist, 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, Tuesday, Wednesday, Thursday 8.30am to 6.30pm.

Friday 8.30am to 4.30pm

Saturday 9am to 12.30pm.

Our key findings were:

• The practice appeared clean and well maintained.
• The provider had infection control procedures which reflected published guidance.
• Staff knew how to deal with emergencies; they required further support to ensure confidence in this. Appropriate medicines and life-saving equipment were available apart from two items.
• The practice staff had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
• The practice had some systems to help them manage risk to patients and staff. The provider needed to review their protocols for undertaking risk assessments for lone working and for staff whose immune status to the Hepatitis B vaccine was unknown. Safety alerts were not received for medical drugs and equipment.
• The provider did not undertake thorough staff recruitment procedures for all staff employed.
• Staff training was monitored; this process was not effective.
• Overall, clinical staff provided patients’ care and treatment in line with current guidelines. We found one clinician was not checking medical histories at every visit. The use of a dental dam, or alternative safety devices, for root canal procedures was not routine for all dentists.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information. The practice had closed-circuit television on the premises; a policy was not in place, nor was a privacy impact assessment.
• The dental professionals were providing preventive care and supporting patients to ensure better oral health.
• The appointment system met patients’ needs.
• The practice had leadership and management. This required strengthening.
• 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 provider dealt with complaints positively and efficiently.
• The provider had suitable information governance arrangements.
• The provider had carried out a disability access assessment of the premises. They could not locate this and they had not met the needs of those who had hearing or sight problems. Staff were using patient’s family members to translate for them and were not aware of the need to use translator services.

We identified regulations the provider was not complying with. They must:

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

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

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

• Review the practice’s protocols for the use of dental dam taking into account the guidelines published by the British Endodontic Society.
• Review the practice’s protocols for checking, and updating if applicable, the medical histories of patients at every visit.
• Review the practice’s referral protocols to ensure all staff are familiar with these.
• Review the practice’s protocols for the use of closed circuit television cameras taking into account the guidelines published by the Information Commissioner's Office.
• Review the practice's waste handling protocols to ensure waste is segregated and disposed of in compliance with the relevant regulations, and taking into account the guidance issued in the Health Technical Memorandum 07-01.

The three people we spoke with told us they were very happy with the service provided. One person said, "They make you very welcome. There's a relaxed atmosphere here." Another person told us, "It's an excellent practice." Other comments included; "I've been very happy coming here. They give me the best treatment." People described the treatment they received as, "brilliant", "excellent" and said they had, "never had any problems" at the practice.

People who used the service told us they were involved in the planning of their treatment and were given information to help inform their decisions.

People were asked for their opinions about the service. One person had commented, "I like it here - the staff are very professional and friendly."

The dental practice had a process in place for assessing medical risks. This meant care and treatment was planned and delivered in a way that ensured people's safety and welfare.

Staff training was kept up to date so that staff could care for people safely and to an appropriate standard.

We found people were protected from the risk of infection because appropriate guidance had been followed and there was an effective system in place to monitor and assess the quality of the service.