We undertook a follow-up focused inspection of Grappenhall Dental Practice on 9 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 was supported by a specialist dental adviser.

We undertook a comprehensive inspection of Grappenhall Dental Practice on 22 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 Regulations 12 and 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 Grappenhall Dental Practice 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 breaches we identified at our inspection on 22 August 2019.

Background

Grappenhall Dental Practice is near the centre of Grappenhall village. The practice provides private dental care for adults and children.

The provider has installed a ramp to facilitate access to the practice for wheelchair users. Car parking is available near the practice.

The dental team includes a principal dentist, three associate dentists, six dental nurses, one of whom is a trainee, and a receptionist. The dental team is supported by a practice manager. The practice has three 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 to the principal dentist, dental nurses, receptionists and the practice manager. We looked at practice policies and procedures, and other records about how the service is managed. We also reviewed the provider’s action plan and evidence sent to us to support the action plan.

The practice is open:

Monday, Wednesday, Thursday and Friday 8.00am to 5.00pm.

Tuesday 8.00am to 8.00pm.

Our key findings were:

• The provider had improved their systems for assessing, monitoring and reducing risk.
• The provider had improved the practice’s infection prevention and control systems and processes.
• Staff followed published guidance when carrying out decontamination and sterilisation procedures.
• The provider had improved their staff recruitment procedures.

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

• Review the practice’s protocols for monitoring and improving the quality and safety of the service. In particular, ensure the recommended routine tests of the ultrasonic bath’s efficiency are carried out, and ensure audits of infection prevention and control are accurate and the results are used to formulate an action plan to identify where improvements can be made.

During this review we visited Grappenhall Dental Centre practice and spoke with six patients.

Patients told us they were given information about their treatment options and costs and confirmed they understood what to expect before consenting to treatment.

Comments received from patients included: “I have been a patient since the practice opened and I’ve always been treated as an individual and with the utmost respect”; “I have always been made aware of any charges prior to giving consent for any proposed treatment and any treatment options have been fully explained” and “I feel so lucky to be a patient here. In my opinion the standard of dentistry and care is excellent.”

Patients spoken with during our visit were complimentary of the standard of care and treatment they had received and confirmed their privacy and dignity was respected.

Comments received included: “I’m quite happy with everything. I have always been well looked after and I have no complaints”; “In my opinion this practice is fantastic and on a scale of one ten I would give them a ten”; “Dr Brown has always put me at ease and I have confidence in him as my dentist” and “The practice is well organised and overall I am very satisfied as a patient.”

Patients spoken with reported that they had no complaints or concerns about the service and systems were in place to safeguard the welfare of people using the service.

We carried out this announced inspection on 22 August 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 second CQC inspector.

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

Grappenhall Dental Practice is near the centre of Grappenhall village and provides private dental care and treatment for adults and children.

The provider has installed a ramp to facilitate access to the practice for wheelchair users. Car parking is available near the practice.

The dental team includes a principal dentist, three associate dentists, six dental nurses, one of whom is a trainee, and a receptionist. The dental team is supported by a practice manager. The practice has three 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 50 people during the inspection about the services provided. The feedback provided was highly positive.

During the inspection we spoke to two dentists, dental nurses, the 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, Wednesday, Thursday and Friday 8.00am to 5.00pm.

Tuesday 8.00am to 8.00pm.

Our key findings were:

• The practice was clean and well maintained.
• Staff knew how to deal with medical emergencies. Appropriate medicines and equipment were available.
• The provider had safeguarding procedures in place and staff knew their responsibilities for safeguarding adults and children.
• The provider had staff recruitment procedures in place. Certain prescribed information was not available.
• The provider had systems in place to manage risk. Insufficient measures were in place to reduce risks.
• 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.
• 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.
• The provider had information governance arrangements in place.
• Patients and staff were encouraged to provide feedback about the services they provided.
• Systems for monitoring quality and safety at the practice were not all operating effectively.

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

• Ensure care and treatment is provided in a safe way to patients

• 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 and procedures for promoting the maintenance of good oral health taking into account the guidelines issued by the Department of Health publication ‘Delivering better oral health: an evidence-based toolkit for prevention’, specifically in relation to guidance about fluoride.
• Review the availability of an interpreter service for patients who do not speak English as their first language.