We undertook a focused inspection of High Street Dental Practice on 21 January 2019. 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 who was supported by a specialist dental adviser.

We undertook a comprehensive inspection of High Street Dental Practice on 18 September 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 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 High Street Dental Practice 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 areas 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 18 September 2018.

Background

High Street Dental practice is in Brownhills, Walsall and provides NHS and private treatment to adults and children.

A portable ramp can be used to gain access for people who use wheelchairs and those with pushchairs. Car parking spaces, including those for blue badge holders, are available at a short stay car park near the practice.

The dental team includes three dentists, four dental nurses; including two trainees and two who also work as receptionists. Two practice managers work at the practice on a part time basis. The practice has two treatment rooms that are in use and one which is used as an office and storage area.

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 High Street dental practice was the principal dentist.

During the inspection we spoke with two practice managers who work on a job share basis. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open: Monday to Wednesday 8.30am to 6pm, Thursday and Friday 8.30am to 5pm, and Saturday 9am – 1.30pm.

Our key findings were:

• A five-year fixed wiring test had been completed at the practice and no issues for action identified.

• Gas safety checks had been undertaken and a gas safety certificate was available.

• Emergency lighting had been serviced on 2 October 2018.

• The practice manager had signed up to receive safety alerts from the Medicines and Health Products Regulatory Agency.

• The practice risk assessment had been amended to include required information. Evidence was available to demonstrate that mitigating action had been taken as required. The practice had not developed a risk assessment for individual members of staff who may be hepatitis B non-immunised or non-responder staff. We were told that this was no longer relevant at the practice.

• The practice’s sharps risk assessments and sharps policy had been amended to include the use of re-sheathing devices for used dental needles.

• Audits were completed on a regular basis. Audits had documented learning points and the resulting improvements were demonstrated. All audits had completed a full cycle.

• A legionella risk assessment had been completed on 11 October 2018 issues for action had been addressed.

• The practice had introduced a structured staff induction process.

• The practice had established a system for the on-going assessment, supervision and appraisal of all staff.

• The practice was giving due regard to the guidelines issued by the Department of Health in the Health Technical Memorandum 01-05: Decontamination in primary care dental practices. Autoclavable bur stands had been purchased. Discussions had been held with staff regarding cleaning and checking burs; any burs that could not be cleaned were to be disposed of in the sharps bin. The infection prevention and control policy had been amended to record that any used dental equipment that could not be decontaminated immediately was to be kept moist as per HTM01-05 guidelines. Staff had signed to confirm that they had read the revised policy. The practice manager confirmed that random checks were being completed to ensure that this process was being adopted.

• The practice had reviewed its systems for checking and monitoring equipment taking into account relevant guidance, ensuring all equipment was well maintained. Monthly visual checks were completed of portable electrical appliances and documentation seen demonstrated this. The provider was completing quality assurance checks on X-ray equipment . This included monthly checks regarding, for example, collimators in place, no warning lights on and no oil leaks. Step wedge tests were also completed for measurement and analysis of x-ray beam quality.

• The practice did not have a hearing loop in place but had identified alternative methods of communicating with patients who were hearing impaired.

• The practice had protocols for the use of closed circuit television cameras taking into account the guidelines published by the Information Commissioner's Office.

We carried out this announced inspection on 18 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 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 not providing well-led care in accordance with the relevant regulations.

Background

High Street Dental practice is in Brownhills, Walsall and provides NHS and private treatment to adults and children.

A portable ramp can be used to gain access for people who use wheelchairs and those with pushchairs. Car parking spaces, including those for blue badge holders, are available at a short stay car park near the practice.

The dental team includes three dentists, four dental nurses; including two trainees and two who also work as receptionists. Two practice managers work at the practice on a part time basis. The practice has two treatment rooms that are in use and one which is used as an office and storage area.

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 High Street dental practice was the principal dentist.

On the day of inspection we obtained feedback from 19 patients.

During the inspection we spoke with two dentists, two dental nurses and two receptionists, who were also qualified dental nurses. We also spoke with both practice managers who work on a job share basis. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open: Monday to Wednesday 8.30am to 6pm, Thursday and Friday 8.30am to 5pm, and Saturday 9am – 1.30pm.

Our key findings were:

• The practice appeared clean and well maintained. Systems were in place to monitor cleanliness but there was limited evidence of action taken once issues were identified.
• Staff were not routinely following guidance and improvements were required to infection prevention and control practices.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available. The practice were to consider the location of these items which were stored individually on a high shelf.
• The practice’s systems to help them manage risk were not robust. Some information recorded in risk assessments was incorrect. Following this inspection, we were told that risk assessments were in the process of being amended.
• The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• The practice had thorough staff recruitment procedures. Induction records were brief and did not clearly demonstrate that the trainee had understood the training provided and been deemed competent. Following this inspection, we received a copy of an amended induction record.
• 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.
• Staff felt involved and supported and worked well as a team.
• The practice asked patients for feedback about the services they provided. Patients were encouraged to complete the NHS Friends and Family Test.
• The practice staff dealt with complaints positively and efficiently.

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 infection control procedures and protocols 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.

• Review the practice's systems for checking and monitoring equipment taking into account relevant guidance and ensure that all equipment is well maintained. In particular provide evidence that visual checks are completed on portable appliances as detailed in the practice risk assessment. Complete quality assurance checks on X-ray equipment in use at the practice.

• Review the practice's responsibilities to take into account the needs of patients with disabilities and to comply with the requirements of the Equality Act 2010.

• Review the practice’s protocols for the use of closed circuit television cameras taking into account the guidelines published by the Information Commissioner's Office.