We carried out an announced comprehensive inspection at Dental Surgery (Mr. Richard Kuncewicz) on 25 August 2015 and at this time breaches of a legal requirement were found. After the comprehensive inspection the practice wrote to us and told us that they would take action to meet the following legal requirements set out in the Health and Social Care Act (HSCA) 2008:

Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2010, Good Governance.

On 21 October 2016 we carried out a focused review of this service under section 60 of the Health and Social care Act 2008 as part of our regulatory functions. The review was carried out to check whether the provider had completed the improvements needed and identified during the comprehensive inspection on 25 August 2015. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Dental Surgery ( (Mr. Richard Kuncewicz) on our website at cqc.org.uk

Our findings were:

We found that this practice was providing well-led care in accordance with the relevant regulations. Improvements needed had been made.

Background

The practice is situated in the Northwood area of Kirby, Liverpool. It is a converted shop within a small shopping precinct. The practice has one principal dentist and one associate dentist. There are two trainee dental nurses and one qualified dental nurse who also acts as the practice manager. The practice provides primary dental services to NHS patients. The practice is open Monday to Friday 9am – 1pm and 2pm -5.30pm.

The principal dentist is the registered provider. A registered provider is registered with the Care Quality Commission to manage the service. Registered providers have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the practice is run.

Our key findings were:

• There were effective systems and processes are in place to assess, monitor and improve the quality and safety of services and to evaluate and improve their practice.
• An infection control audit had been undertaken based on the infection prevention society audit tool.
• Radiograph audits had been undertaken six monthly and results reviewed.

The practice had also acted upon other recommendations:

• Systems and processes were in place to ensure that national patient safety and other relevant alerts and guidance was followed and actions taken documented.
• Equipment and medicines to manage medical emergencies were in place and reflected guidance issued by the Resuscitation Council (UK), and the General Dental Council (GDC) standards for the dental team. Weekly checks were undertaken and documented.
• A documented recruitment policy and procedure was in place.
• An appraisal system had been implemented that included assessment of performance and development needs. We saw evidence of staff appraisals having been carried out.
• A training and development plan for practice nurses was in place.
• Staff had received training and were aware of the requirements of the Mental Capacity Act (MCA) 2005 and their responsibilities under the Act as it related to their role.
• Improvements had been made to the practice premises and facilities which enabled suitable cleaning to take place in line with guidance and legislation to minimise the risk of infection.
• Staff meetings were documented and had been held on a regular quarterly basis.

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

Review the recruitment policy and procedures to ensure the requirement to obtain an appropriate Disclosure and Barring Service (DBS) check is documented and carried out prior to recruitment.

We carried out an announced comprehensive inspection at Dental Surgery (Mr. Richard Kuncewicz) on 25 August 2015 and at this time breaches of a legal requirement were found. After the comprehensive inspection the practice wrote to us and told us that they would take action to meet the following legal requirements set out in the Health and Social Care Act (HSCA) 2008:

Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2010, Good Governance.

On 21 October 2016 we carried out a focused review of this service under section 60 of the Health and Social care Act 2008 as part of our regulatory functions. The review was carried out to check whether the provider had completed the improvements needed and identified during the comprehensive inspection on 25 August 2015. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Dental Surgery ( (Mr. Richard Kuncewicz) on our website at cqc.org.uk

Our findings were:

We found that this practice was providing well-led care in accordance with the relevant regulations. Improvements needed had been made.

Background

The practice is situated in the Northwood area of Kirby, Liverpool. It is a converted shop within a small shopping precinct. The practice has one principal dentist and one associate dentist. There are two trainee dental nurses and one qualified dental nurse who also acts as the practice manager. The practice provides primary dental services to NHS patients. The practice is open Monday to Friday 9am – 1pm and 2pm -5.30pm.

The principal dentist is the registered provider. A registered provider is registered with the Care Quality Commission to manage the service. Registered providers have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the practice is run.

Our key findings were:

• There were effective systems and processes are in place to assess, monitor and improve the quality and safety of services and to evaluate and improve their practice.
• An infection control audit had been undertaken based on the infection prevention society audit tool.
• Radiograph audits had been undertaken six monthly and results reviewed.

The practice had also acted upon other recommendations:

• Systems and processes were in place to ensure that national patient safety and other relevant alerts and guidance was followed and actions taken documented.
• Equipment and medicines to manage medical emergencies were in place and reflected guidance issued by the Resuscitation Council (UK), and the General Dental Council (GDC) standards for the dental team. Weekly checks were undertaken and documented.
• A documented recruitment policy and procedure was in place.
• An appraisal system had been implemented that included assessment of performance and development needs. We saw evidence of staff appraisals having been carried out.
• A training and development plan for practice nurses was in place.
• Staff had received training and were aware of the requirements of the Mental Capacity Act (MCA) 2005 and their responsibilities under the Act as it related to their role.
• Improvements had been made to the practice premises and facilities which enabled suitable cleaning to take place in line with guidance and legislation to minimise the risk of infection.
• Staff meetings were documented and had been held on a regular quarterly basis.

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

Review the recruitment policy and procedures to ensure the requirement to obtain an appropriate Disclosure and Barring Service (DBS) check is documented and carried out prior to recruitment.

We carried out an announced comprehensive inspection on 25 August 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. Improvements were needed.

Background

The practice is situated in the Northwood area of Kirby, Liverpool. It is a converted shop within a small shopping precinct. The practice has one principal dentist and one associate dentist. There are two trainee dental nurses and one qualified dental nurse who also acts as the practice manager. The practice provides primary dental services to NHS patients. The practice is open Monday to Friday 9am – 1pm and 2pm -5.30pm.

The principal dentist is the registered provider. A registered provider is registered with the Care Quality Commission to manage the service. Registered providers 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 14 CQC comment cards that had been left for patients to complete prior to our visit and spoke to four patients on the day of inspection, about the services provided. All of the comment cards seen and patients spoken to reflected positive comments about the staff and the services provided. Patients commented that the practice appeared clean; they found the staff very caring and friendly. They had trust and confidence in the dental treatments and said explanations were clear and understandable. Emergency appointments were available on the same day and appointments usually ran on time.

Our key findings were:

• The practice recorded and analysed significant events and complaints and cascaded learning to staff when they occurred.
• Staff had received safeguarding 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 deal with medical emergencies and emergency medicines and emergency equipment were available.
• Infection control procedures were in place.
• Patients ‘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.
• The practice staff felt involved and worked as a team.

• The practice sought feedback from staff and patients about the services they provided.

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

• Ensure effective systems and processes are in place to assess, monitor and improve the quality and safety of services and to evaluate and improve their practice

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 that national patient safety and other relevant alerts and guidance is followed and actions taken documented.
• Review availability of equipment and medicines to manage medical emergencies giving due regard to guidelines issued by the Resuscitation Council (UK), and the General Dental Council (GDC) standards for the dental team.
• Ensure they have a documented recruitment policy and procedure in place to follow when recruiting new members of staff.
• Ensure formal appraisals are carried out annually to assess performance and develop training plans
• Review staff awareness of the requirements of the Mental Capacity Act (MCA) 2005 and ensure all staff are aware of their responsibilities under the Act as it relates to their role
• Ensure the premises are suitable to ensure adequate cleaning of surfaces can take place in line with HTM01 05 Decontamination in primary care dental practices

As this was a follow up review, we did not speak with people who used the service.

We spoke to three people who attended the surgery on the day of our visit. They were very positive about the support that they received.

Comments included:

"They are all so friendly and everything is always explained",

"The dentist discusses what I need and any options I have. He tells me everything I need to know",

"They are very good here, I've never had a moments pain",

"They always follow up to make sure I come to my next appointment",

"I can always get an appointment even in an emergency they make time for me",

“The staff are absolutely lovely, friendly and welcoming it's the reason that I use this dentist. My whole family comes here my children and my grand children",

"The dentist is so kind and gentle he always puts me at my ease. I've had bad experiences with dentists but not here" and

"The best thing about this surgery is the lovely staff".

People attending for appointments told us that "it’s always clean", "the dentist always uses gloves" and "it looks and smells clean to me".