We carried out this announced inspection on 5 June 2017 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We planned the inspection in response to concerns raised to the CQC in order 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 providing well-led care in accordance with the relevant regulations.

Background

Furzton Dental Centre is based in Milton Keynes and provides private treatment to patients of all ages. It is one of five practices in the area owned by Boodles Limited.

There is level access for people who use wheelchairs and pushchairs. Car parking spaces, including for patients with disabled badges, are available near the practice.

One dentist works at the practice and is supported by a pool of eight nurses and five receptionists, who work across all five practices owned by the company. The practice has two treatment rooms.

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. At the time of the inspection the practice did not have a registered manager in post.

On the day of inspection we collected 12 CQC comment cards filled in by patients and spoke with two other patients. This information gave us a positive view of the practice.

During the inspection we spoke with the dentist, a dental nurse, a receptionist 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 between 8.30am and 5.30pm

Our key findings were:

• Staff understood and fulfilled their responsibilities to raise and report incidents and near misses.

• Premises and equipment were visibly clean, secure, properly maintained and kept in accordance with current legislation and guidance.

• There were sufficient numbers of suitably qualified and competent staff. Members of the dental team were up-to-date with their continuing professional development and supported to meet the requirements of their professional registration

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

• 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 had effective leadership. Staff felt involved and supported, and worked well as a team.

• The practice asked staff and patients for feedback about the services they provided.

We identified an area of notable practice.

In April 2017, staff invited pupils from a local primary school to visit a sister practice to educate them in oral health. We viewed feedback from the head teacher of the school which stated that the children loved brushing the giant set of teeth and looking at the equipment in the treatment room.

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

• Review the practice’s arrangements for receiving and responding to patient safety alerts, recalls and rapid response reports issued from the Medicines and Healthcare products Regulatory Agency (MHRA) and through the Central Alerting System (CAS), as well as from other relevant bodies such as, Public Health England (PHE).

• Review the current legionella risk assessment and implement any recommendations.

We carried out this inspection to follow up on concerns we found at an inspection of this practice on 30 January 2015. At the inspection on 30 January 2015 we found that the practice was not meeting the regulations in relation to cleanliness and infection control, safety and suitability of (X-ray) equipment, requirements relating to workers, supporting workers, assessing and monitoring the quality of service provision and records. After that inspection, the practice wrote to us to say what they would do to meet the relevant regulations.

We undertook this focused inspection on 5 August 2015 to check that the practice had completed their action plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last inspection, by selecting the 'all reports' link for Furzton Dental Centre on our website at www.cqc.org.uk.

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 responsive?

We found 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.

Furzton Dental Centre is a general dental practice in Furzton, Milton Keynes offering NHS and private dental treatment to adults and children.

The premises consists of a waiting area adjacent to the reception desk and two treatment rooms. There is also a separate decontamination room.

The staff at the practice consist of two dentists, two dental nurses and a receptionist. The practice manager divides their time between this practice and another of the provider’s locations, Boodle Dental Surgery.

The practice does not currently have a 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.

The practice told us after the inspection they are in the process of submitting an application for a registered manager.

Our key findings were:

• There were systems in place for identifying, investigating and learning from incidents relating to the safety of patients and staff members.

• There were effective systems in place to reduce the risk and spread of infection. We found the treatment rooms, decontamination room and equipment appeared very clean.

• The practice had systems in place for the safe management of dental radiography.

• There were effective recruitment and selection procedures in place.

• Staff were supported to enable them to deliver care and treatment to an appropriate standard.

• There was an effective system in place for acknowledging, recording, investigating and responding to complaints, concerns and suggestions made by patients.

• The practice had comprehensive and effective quality assurance and risk management structures in place.
• Records relating to the management of the practice were appropriately maintained and could be located promptly when required.

This was an unannounced, responsive inspection. We had received information of concern that suggested a number of regulations were not being met by the provider. We carried out the inspection as part of a team which also included a specialist dental advisor. Due to the nature of this inspection we did not speak with patients.

On the day of our inspection both surgeries were in use.

We found the location to be clean and tidy; we found that the practice had effective systems to reduce the risk and the spread of infection which staff did not always follow.

The practice was unable to provide detailed service records for all radiography equipment and some units did not have a critical assessment report. The provider had not appointed a Radiation Protection Advisor (RPA) or suitable Radiation Protection Supervisors (RPS) to oversee the safe use of radiation and to comply with the radiation regulations.

The provider had not waited for the results of criminal records checks from the disclosure and barring service (DBS) before staff began work and staff files were incomplete.

The provider did not have effective systems in place to regularly assess and monitor the quality of service that patients received.

We found that practice documents were incomplete and did not serve the purpose for which they were intended.

This was a follow up inspection which focussed on areas of concern identified at the last inspection. As a result, it was not necessary to talk to people that used the service.

We found that the provider had made the required improvements to the service. We found the premises were clean and free from dust and the dental instruments were within their expiry dates. We looked at the clinical waste bin and found that this was secure and could not be accessed by members of the public. We also found that the provider had suitable policies in place and had cleaning records to show that appropriate cleaning had taken place.

We spoke with people who use the service and they told us that they were happy with the treatment provided at the practice. One person told us that they have never had any problem with the service and despite ongoing building work the treatment room was very clean. We found concerns in relation to cleanliness and infection control.