We carried out a focused inspection of Highview Dental Practice on 5 March 2018 to follow up concerns we originally identified during a comprehensive inspection at this practice on 15 February 2017 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 to people’s needs?
• Is it well-led?

When one or more of the five questions is 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.

At the previous comprehensive inspection we found the registered provider was providing safe, effective, caring and responsive care in accordance with relevant regulations. We judged the practice was not providing well-led care in accordance with 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 Highview Dental Practice on our website www.cqc.org.uk.

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 adequate improvements to put right the shortfalls and deal with the regulatory breach we found at our inspection on 15 February 2017. The provider must ensure that the newly implemented improvements are embedded and sustained in the long-term in the practice.

There were areas where the provider could make improvements and should

Review the practice’s responsibilities to the needs of people with a disability and the requirements of the Equality Act 2010 and ensure an Equality Act audit is undertaken for the premises.

Review the staff supervision protocols and ensure an effective process is established for the on-going appraisal of all staff.

Review the practice's current audit protocols to ensure audits of key aspects of service delivery are undertaken at regular intervals and where applicable learning points are documented and shared with all relevant staff.

We carried out an announced comprehensive inspection on 15 February 2017 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

High View Dental Practice has a principal dentist who works full time, two qualified dental nurses who are registered with the General Dental Council (GDC) and a practice manager who also works on the reception. The practice’s opening hours are 9am to 6pm on Monday, Wednesday and Thursday, 9am to 7.30pm on Tuesday and 8am to 1pm on Friday. The practice is closed for one hour each day at lunchtime.

Highview Dental Practice provides NHS and private dental treatment for adults and children. The practice has two dental treatment rooms on the ground floor. There is a separate decontamination room for cleaning, sterilising and packing dental instruments. There is also a reception, waiting area and three patient toilets on the ground floor.

Before the inspection we sent Care Quality Commission comments cards to the practice for patients to complete to tell us about their experience of the practice and during the inspection we spoke with patients. We received feedback from nine patients who provided a positive view of the services the practice provides. All of the patients commented that the practice was always clean, staff were efficient and friendly and the quality of care was good.

Our key findings were

• Systems were in place for recording significant events, accidents and safety alerts although there was no documentary evidence to demonstrate that learning outcomes had been discussed with staff.
• There were sufficient numbers of suitably qualified staff to meet the needs of patients.
• Patients were treated with dignity and respect.
• The practice was visibly clean and well maintained.
• Infection control procedures in place were not robust, staff were re-using some single use items, the practice’s infection prevention and control audits were not being completed on a six monthly basis and there was no evidence to demonstrate action had been taken to address issues identified. There was no evidence that one piece of equipment used in the decontamination process had been serviced and maintained.
• Emergency equipment for dealing with medical emergencies reflected published guidelines. Staff had completed annual update training regarding dealing with medical emergencies.
• The appointment system met the needs of patients and waiting times were kept to a minimum.
• Governance arrangements in place for the smooth running of the practice were not robust; the practice did not have a structured plan in place to continuously audit quality and safety including infection control and radiographs.

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

• Ensure systems and processes are operated effectively to assess and monitor the service and risks in accordance with the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This includes: implementing an effective audit system; meeting the requirements of the Control of Substances Hazardous to Health (COSHH) Regulations 2002; working in accordance with the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013; meeting the Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections; the management of medicines and equipment; servicing, maintenance and ongoing checks of equipment; ensuring staff remain up to date with their continuing professional development requirements; the management of effective fire safety training including the provision of fire drills; the on-going assessment and supervision of all staff employed and ensuring dental care records are maintained appropriately.

There were areas where the provider could make improvements and should:

• Review the practice’s responsibilities to the needs of people with a disability and the requirements of the Equality Act 2010 and ensure an Equality Act audit is undertaken for the premises.
• Review the practice’s protocols for the use of rubber dam for root canal treatment giving due regard to guidelines issued by the British Endodontic Society.
• Review staff awareness of the requirements of the Mental Capacity Act (MCA) 2005 and ensure all staff are aware of their responsibilities under the Act as it relates to their role.

During our inspection of 6th March 2013 we found that the provider did not have in place robust procedures that would ensure that only suitable staff were employed to care for and provide treatment for people. The provider sent us an action plan setting out how they intended to improve.

During this inspection we spoke to the dentist, the practice manager and a newly recruited member of staff. We did not speak to people as their feedback would not have been relevant.

We found that the practice now had a robust recruitment and selection policy and that existing staff had also been made subject to some of the checks in place for newly recruited staff. Those checks included such things as; signed annual health declarations and annual declarations confirming that there had been no change in respect of Criminal Record Bureau (CRB) status. The changes made should ensure that only suitable staff are employed.

During our inspection processes we spoke to two people who had recently used this dental practice or were receiving treatment. People told us that they were happy with the service that had been provided and the treatment they had received. One person told us, “I have been going to that dentist for 15 years. I think they are excellent”. Another person said, “The service is very good. I am really happy with the care and treatment I have received”.

People told us and we saw that staff were helpful and polite. We found that people had received the care and treatment they needed. People told us that they were informed about the treatment they needed and were given choices and options regarding this.

We saw that processes were in place to prevent infection. People we spoke with had no concerns about the cleanliness of the practice. People made positive remarks about the recent refurbishment work that had been undertaken at the practice. They told us that the premises were bright, clean and new.

Recruitment processes had not been as thorough and safe as they should have been to give assurance that only suitable staff had been employed.

We saw that processes were in place to monitor the quality of the service provided to benefit the people who used it.