We undertook a follow-up, desk-based inspection of Drakes Dental Care on 8 January 2019. This inspection was carried out to review in detail the actions taken by the 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 had remote access to a specialist dental adviser.

We undertook a comprehensive inspection of Drakes Dental Care on 19 August 2018 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. At a comprehensive inspection we always ask the following five questions to get to the heart of patients’ experiences of care and treatment:

• Is it safe?

• Is it effective?

• Is it caring?

• Is it responsive?

• Is it well-led?

We found the 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 Drakes Dental Care on our website www.cqc.org.uk.

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

As part of this inspection we asked:

• Is it well-led?

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 identified at our inspection on 19 August 2019.

Background

Drakes Dental Care is located near the centre of the town. The practice provides NHS and private dental care for adults and children.

There is level access to facilitate entrance to the practice for people who use wheelchairs and pushchairs. Car parking is available near the practice.

The dental team includes four dentists, four dental nurses, one of whom is a trainee, two dental hygiene therapists, and two receptionists. The dental team is supported by a practice manager, who is also a qualified dental nurse. The practice has four 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.

We reviewed the provider’s action plan and evidence sent to us to support the action plan. We found this contained sufficient information to identify to CQC how the provider planned to comply with the regulation.

The practice is open:

Monday 9.00am to 7.30pm

Tuesday, Wednesday, Thursday 9.00am to 5.30pm

Friday 8.00am to 2.00pm.

Our key findings were:

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

• Implement all the recommended actions identified in the practice's Legionella risk assessment, taking into account the guidelines issued by the Department of Health in the Health Technical Memorandum 01-05: Decontamination in primary care dental practices, and having regard to The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance.’

We carried out this announced inspection on 19 September 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 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

Drakes Dental Care is located near the centre of the town. The practice provides NHS and private dental care and treatment for adults and children.

There is level access to facilitate entrance to the practice for people who use wheelchairs and pushchairs. Car parking is available near the practice.

The dental team includes four dentists, four dental nurses, one of whom is a trainee, two dental hygiene therapists, and two receptionists. The dental team is supported by a practice manager, who is also a qualified dental nurse. The practice has four 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.

We received feedback from 17 people during the inspection about the services provided. The feedback provided was positive.

During the inspection we spoke to the principal dentist, an associate dentist, a dental hygiene therapist, dental nurses, a receptionist, the group manager and the covering practice manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday 9.00am to 7.30pm

Tuesday, Wednesday, Thursday 9.00am to 5.30pm

Friday 8.00am to 2.00pm.

Our key findings were:

• The practice was clean and well maintained.
• The practice had infection control procedures in place.
• The provider had safeguarding procedures in place and staff knew their responsibilities for safeguarding adults and children.
• Staff knew how to deal with medical emergencies. Appropriate medicines and equipment were available, with the exception of four sizes of oxygen masks.
• The provider had staff recruitment procedures in place. Not all the required information was available.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• The dental team provided preventive care and supported patients to achieve better oral health. Not all the clinicians were aware of the guidance about periodontal disease screening.
• The appointment system took account of patients’ needs.
• The provider had a procedure in place for dealing with complaints. The practice dealt with complaints positively and efficiently.
• The practice had a leadership and management structure in place.
• Staff felt involved and supported and worked well as a team.
• The practice asked patients and staff for feedback about the services they provided.
• The provider had systems in place to manage risk. Some of the risks had not been reduced sufficiently.
• The provider had information governance arrangements 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.

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 practice's recruitment policy and procedures to ensure accurate, complete and detailed records are maintained for all staff.
• Review the practice's protocols for patient assessments and ensure they take into account relevant nationally recognised evidence-based guidance in relation to periodontal disease.