We undertook a focused inspection of Fourways Dental Surgery on 19 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.

We undertook a comprehensive inspection of Fourways Dental Surgery on 5 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 and was in breach of regulation 17 Good Governance 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 Fourways Dental Surgery on our website www.cqc.org.uk.

As part of this inspection we asked:

• Is it 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’s 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 breaches we found at our inspection on 5 April 2018

Background

Fourways Dental Surgery is in Sevenoaks and provides a very small NHS contract and private treatment for adults and children

There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces, including some for blue badge holders, are available adjacent the practice.

The dental team includes five dentists, two dental hygienists, four dental nurses, two trainee dental nurses and two receptionists. The practice has four treatment rooms.

The practice is owned by a partnership 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 Fourways Dental Surgery was one of the principal dentists.

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

The practice is open:

• Monday to Friday 8.30am – 1.00pm & 2.00pm – 5.30pm.

• Saturdays 08.30am – 1.00pm. (alternate Saturdays)

• Closed Sundays.

We carried out this unannounced inspection on 5 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

Fourways Dental Surgery is in Borough Green in Sevenoaks and provides NHS and private treatment to patients of all ages.

There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces, including some for blue badge holders, are available near the practice.

The dental team includes three dentists, two dental hygienists, four dental nurses (one of which is the practice manager), two trainee dental nurses and two receptionists. The practice has four treatment rooms.

The practice is owned by a partnership 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 Fourways Dental Surgery was one of the principal dentists.

On this occasion we did not supply any CQC comment cards as this was an unannounced inspection. We did speak with three patients following our inspection over the telephone.

During the inspection we spoke with three dentists, three dental nurses, two receptionists 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 to Friday 8.30am – 1.00pm & 2.00pm – 5.30pm.
• Saturdays 08.30am – 1.00pm. (alternate Saturdays)
• Closed Sundays.

Our key findings were:

• The practice appeared clean and well maintained.
• The practice had infection control procedures which reflected published guidance.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• The practice did not have systems to help them manage risk.
• The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• The practice did not have robust staff recruitment procedures.
• The clinical staff provided patients’ care and treatment in line with current guidelines.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• The practice was providing preventive care and supporting patients to ensure better oral health.
• The appointment system met patients’ needs.
• The practice asked staff and patients for feedback about the services they provided.
• The practice dealt with complaints positively and efficiently.
• The practice had suitable information governance arrangements.

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

• Ensure introduction of a system or process to monitor and mitigate risks, incidents and events for the safety of patients and staff and learn from these.
• Ensure complete contemporaneous records are recorded and retained by the practice in relation to sedation carried out.
• Ensure that recruitment documents identified in Schedule 3 Of the Health and Social Care Act (2008) are obtained for all staff employed at the practice and visiting clinicians.

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 and update on an annual basis all of their policies, procedures and protocols.

We carried out an unannounced comprehensive inspection on 8 September 2016 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 providing well-led care in accordance with the relevant regulations

Background

Fourways Dental Surgery is located in Sevenoaks and offers general dentistry services to patients through a recognised dental plan on a private basis and NHS treatment options for patients who are exempt from payment and children. The practice has three dentists and two hygienists who are supported by a practice manager, two qualified and registered dental nurses, two student dental nurses and two receptionists.

The practice has four treatment rooms, over two floors, reception and waiting areas, a decontamination room and staff facilities.

The practice is open: Monday – Friday 8.30am to 5.30pm and Saturdays by appointment only.

The principal dentist 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 did not provide CQC comment cards to the practice as this was an unannounced inspection. We were able to speak with two patients on the day of our inspection and six over the telephone following our inspection. Their comments were very positive about the staff and the service. Patients commented that the practice was clean and hygienic, and they found the staff friendly, considerate and caring. They had trust in the staff and confidence in the dental treatments, and said that they were always given clear, detailed and understandable explanations about dental treatment. They also commented that the dentists put patients at ease, had their patient’s best interests at heart and listen carefully.

Our key findings were:

• The practice recorded and analysed significant events, incidents and complaints and cascaded learning to staff.
• 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
• equipment were readily available.
• Premises and equipment were clean, secure and properly maintained.
• Infection control procedures were in place and the practice followed published guidance.
• Staff were supported to deliver effective care, and opportunities for training and learning were available.
• Clinical staff were up to date with their continuing professional development and met the requirements of their professional registration.
• Patient’s care and treatment was planned and delivered in line with evidence-based guidelines, and current practice and legislation.
• Patient’s received clear explanations about their proposed treatment, costs, benefits and risks and were involved in making decisions about it.
• Patient’s were treated with dignity and respect and confidentiality was maintained.