We carried out a desk based follow up inspection on 22 June 2016 to check the practice had achieved compliance following our inspection of 27 January 2016. We concentrated on the following key question: Are services well-led?

Our findings were:

Are services well-led?

We found that this practice was providing well-led care in accordance with the relevant regulations.

Our key findings were:

• Patients could be assured the practice was carrying out a schedule of audits to monitor the quality of both clinical and non-clinical areas of the practice. The audits were being used to drive improvements in the service.

We carried out an announced comprehensive inspection on 27 January 2015 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 not providing well-led care in accordance with the relevant regulations.

Background

Handside Dental Surgery is a private general dental practice in Welwyn Garden City, Hertfordshire offering private dental treatment to adults and children. The practice also offers in house specialist dental treatment such as endodontics (root canal therapy), periodontics (specialism in prevention and treatment of the inflammatory disease affecting the supporting structures of the teeth) and prosthodontics (specialism in replacement or reconstruction of lost or damaged teeth).

The premises are located on the ground and first floor and consist of three dental treatment rooms, a dental hygienist treatment room, a reception area, a waiting room and a designated decontamination room.

The staff at the practice consist of a practice manager, a principal dentist, three associate dentists, an endodontic specialist, a prosthodontic specialist, a periodontal specialist, four part-time dental hygienists, four dental nurses and two trainee dental nurses. One of the dental nurses is the head receptionist; the reception is staffed on a rota basis by the dental nurses.

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.

Our key findings were:

• There was an induction and training programme for staff to follow which ensured they were skilled and competent in delivering safe and effective care and support to patients.

• The practice ensured staff maintained the necessary skills and competence to support the needs of patients.

• There were effective systems in place to reduce the risk and spread of infection. We found the treatment rooms and equipment were visibly clean.

• There were systems in place to check equipment had been serviced regularly, including the dental air compressor, autoclaves, fire extinguishers, dental laser and the X-ray equipment.

• We found the dentists and dental hygienists regularly assessed each patient’s gum health and dentists took X-rays at appropriate intervals.

• The practice kept up to date with current guidelines when considering the care and treatment needs of patients.

• The practice placed a strong emphasis on the promotion of oral and general health and the prevention of dental disease. Appropriate information and advice was available according to patients’ individual needs.

• Staff had been trained to handle emergencies and appropriate medicines and life-saving equipment were readily available.

• Patients received clear explanations about their proposed treatment, costs, benefits and risks and were involved in making decisions about it.

• Patients were treated with dignity and respect and confidentiality was maintained.

• The appointment system met the needs of patients and waiting times were kept to a minimum.

• There was an effective complaints system and the practice was open and transparent with patients if a mistake had been made.

• Staff demonstrated knowledge of the practice whistleblowing policy and were confident they would raise a concern about another staff member’s performance if it was necessary.

• At our visit we observed staff were kind, caring and professional. Some staff had worked at the practice for a long time and demonstrated they knew patients well when they greeted them.

• There was an effective system in place to act on feedback received from patients and staff.

We identified regulations that were not being met and the provider must:

• Ensure audits of various aspects of the service, such as infection control and radiography are undertaken at regular intervals to help improve the quality of service. The practice should also ensure all audits have documented learning points and the resulting improvements can be demonstrated.