We undertook a focused inspection of Denteam Dental Care on 15 November 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.

Previously, we had undertaken a comprehensive inspection 17 April 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 in accordance with the relevant regulations 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 Denteam Dental Care 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

Denteam Surgery is in Norwich and provides mostly NHS and some private treatment to patients of all ages. It serves about 78,000 patients and opens on Monday to Thursday, from 8.20am to 5.30pm and on Fridays from 8.20am to 4.30pm. It also opens one Saturday morning a month, from 8.50am to1pm.

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

The dental Team includes six dentists, two practice managers ten, dental nurses four receptionists and one hygienist. The practice has six 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.

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

Our findings were:

The provider had made good improvements in relation to the regulatory breach we found at our previous inspection and was now was providing well-led care in accordance with the relevant regulations.

We carried out this announced inspection on 17 April 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 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 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

DenTeam Surgery is in Norwich and provides mostly NHS and some private treatment to patients of all ages. It serves about 78,000 patients and opens on Monday to Thursday, from 8.20am to 5.30pm and on Fridays from 8.20am to 4.30pm. It also opens one Saturday morning a month, from 8.50am to1pm.

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

The dental team includes six dentists, a practice manager, nine dental nurses and four reception staff. The practice has six 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 43 CQC comment cards filled in by patients and spoke with three other patients.

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

Our key findings were:

• We received positive comments from some patients about the dental care they received and the staff who delivered it. However, other patients raised concerns with the behaviour and attitude of one dentist.

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

• The appointment system met patients’ needs and the practice opened one Saturday a month. Text and email appointment reminders were available.

• The practice was clean and well maintained, and had infection control procedures that reflected published guidance.

• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.

• The clinical staff provided patients’ care and treatment in line with current guidelines.

• Patients’ complaints were managed well, although learning from them was not shared across the staff team.

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

• The provider did not have all emergency medicines or equipment in line with the British National Formulary (BNF) guidance for medical emergencies in dental practice

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

• Risk assessment to identify potential hazards and audit to improve the service were limited.

• Not all staff received regular appraisal of their performance and none had personal development plans in place.

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. This includes the recording and monitoring of significant events; assessing potential risks, strengthening audit systems and ensuring all staff receive regular appraisal of their performance.

• Ensure the practice's recruitment policy and procedures are suitable and the recruitment arrangements are in line with Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 to ensure necessary employment checks are in place for all staff.

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 staff awareness of Gillick competency and ensure all staff are aware of their responsibilities in relation to this.

• Review procedures for effectively managing staff performance.

• Review the training, learning and development needs of staff members and implement an effective process for the on-going assessment and supervision of all staff employed.

• Review the practice’s arrangements for ensuring good governance and leadership.