We undertook a follow up desk based inspection Horsforth Smile Clinic on 14 November 2018. 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 completed by a CQC inspector.

We undertook a comprehensive inspection of The Dental Practice on 20 August 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 in accordance with the relevant regulations 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 Horsforth Smile Clinic on our website www.cqc.org.uk.

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.

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 breach we found at our inspection on 20 August 2018.

Background

Horsforth Smile Clinic is in the centre of Horsforth and provides NHS and private dental treatment to adults and children.

There is level access for people who use wheelchairs and those with pushchairs. Car parking and public transport facilities are available near the practice.

The dental team includes four dentists (one of whom is a foundation dentist), five dental nurses (one of whom is a trainee), one dental hygiene therapist, a practice manager and a receptionist. The practice has five treatment rooms.

Horsforth Smile Clinic is a training practice for trainee dentists.

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.

The practice is open: Monday, Wednesday and Thursday 9am-5:30pm, Tuesday 9am-7:30pm, Friday 9am-2:00pm.

Our key findings were:

• The practice had systems to identify and manage risk effectively, including fire safety, electrical and gas safety.
• The practice had improved safeguarding vulnerable adults and children processes.
• A revised recruitment policy was now in place and DBS checks had been completed for all staff.
• A system was in place to audit infection prevention and control.

Other improvements were;

• The sharps risk assessment had been reviewed and revised.
• Prescription pads were now stored securely at the practice
• CCTV signage was now in place to ensure patients were aware they were being recorded.

We carried out this announced inspection on 20 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 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 remotely 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

Horsforth Smile Clinic is in the centre of Horsforth and provides NHS and private dental treatment to adults and children.

There is level access for people who use wheelchairs and those with pushchairs. Car parking and public transport facilities are available near the practice.

The dental team includes four dentists (one of whom is a foundation dentist), five dental nurses (one of whom is a trainee), one dental hygiene therapists, a practice manager and a receptionist. The practice has five treatment rooms.

Horsforth Smile Clinic is a training practice for trainee dentists.

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.

On the day of inspection we 50 CQC comment cards filled in by patients.

During the inspection we spoke with three dentists, four dental nurses and a receptionist. We looked at the practice’s policies and procedures and other records about how the service is managed.

The practice is open: Monday, Wednesday and Thursday 9am-5:30pm, Tuesday 9am-7:30pm, Friday 9am-2:00pm.

Our key findings were:

• The practice appeared clean and well maintained.
• The practice staff had infection control procedures which reflected published guidance. The infection prevention and control audit needed to be updated.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• The practice had some systems to help them manage risk to patients and staff. We found areas that required improvement.
• Legionella and cone beam computed tomography (CBCT) machine recommendations had not been adhered to and safety certificates for gas and electricity were not in place.
• Safeguarding arrangements required review to ensure all staff maintained up to date training.
• A staff recruitment procedure was in place. The recruitment procedure did not follow the current guidance and some essential staff recruitment checks were not in place.
• 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 staff and patients for feedback about the services they provided.
• The practice staff dealt with complaints positively and efficiently.
• Clinical audits were completed
• The practice staff had suitable information governance arrangements.

We identified regulations the provider was not complying with. They must:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

There were areas where the provider should make improvements.

• Review the practice’s systems for assessing, monitoring and mitigating the various risks arising from the undertaking of the regulated activities. In particular the sharps risk assessment.
• 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 (ICO).

During the inspection we spoke with patients who told us they have been coming to the dental practice for many years. They spoke very highly of the service and of the people working at the practice.

People told us staff were professional in their approach to providing care.

Some of the comments included;

“Staff are polite and respectful.”

“You are given clear explanations of your treatment.”

“Service is prompt and staff listen.”

“Staff are friendly and helpful” and “The practice is extremely clean and tidy.”

“Reminders for appointments are sent out by the practice.”

“The dentist is good at putting you at ease.”

“The place is friendly and welcoming.”