We carried out an announced follow up inspection on 10 May 2016 to ask the practice the following key questions which we found the practice required actions; Are services safe, and well-led?

Our findings were:

Are services safe?

We found that this practice was now providing safe care in accordance with the relevant

Are services well-led?

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

Background

CQC inspected the practice on 10 November 2015 and asked the provider to make improvements regarding Regulation 12: Safe care and treatment and Regulation 17: Good Governance. We checked these areas as part of this follow up inspection on 10 May 2016 and found this had been resolved.

On the 10 November 2015 we found that the provider could not demonstrate they took appropriate actions to:

• Assess, monitor and mitigate the risks to the health and safety of patients, staff and visitors.

• Ensure that the premises used by the service provider are safe to use for their intended purpose and are used in a safe way.

• Ensure that the equipment used by the service provider for providing care and treatment to a patient is safe for such use and is used in a safe way.

• Ensure that systems are in place for assessing the risk of, and preventing, detecting and controlling the spread of, infections, including those that are health associated.

• Ensure there is an effective approach for identifying where quality and/or safety is being compromised and steps are taken in response to issues. These include all audits and risk assessments undertaken within the practice.

• Establish systems to support communication about the quality and safety of services and what actions have been taken as a result of audits, concerns, complaints and compliments.

• Ensure that audit processes function well and have a positive impact in relation to quality governance, with clear evidence of actions to resolve concerns.

• Establish processes to actively seek the views of patients and should be able to provide evidence of how they have taken these views into account in relation to decisions.

The practice was situated in a listed building within Lancaster University Campus. The practice provides NHS and private dental treatment to both students and staff at the university and to the general public who live in the immediate area of the practice.

The practice is operated by a single handed dentist. Staffing for the practice was managed from the provider’s sister practice also in Lancaster. There is a dental hygienist who works at the practice every Tuesday and the dentist provides treatment on a Monday, Thursday and Friday. There are no evening or weekend surgery hours available. There is always a receptionist and a dental nurse in the practice when care is being provided. The practice manager is based at the providers sister location.

The principal dentist is registered with the Care Quality Commission (CQC) as an individual. 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 in this follow up inspection were:

The provider had taken actions to address all the concerns highlighted above and in the report of the 10 November 2016.

We carried out an announced comprehensive inspection on 10 November 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 not 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

The practice is a single handed dentist situated in the campus grounds of Lancaster University. Staffing for the practice was managed from the provider’s sister practice also in Lancaster. There is a dental hygienist who works at the practice every Tuesday and the dentist provides treatment on a Monday, Thursday and Friday. There are no evening or weekend surgery hours available. There is always a receptionist and a dental nurse in the practice when care is being provided. The practice manager is based at the providers sister location.

The dentist is the registered provider for the practice. 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.

We viewed 11 CQC comment cards that had been left for patients to complete, prior to our visit, about the services provided. All of the comment cards reflected positive comments about the staff and the services provided. Patients commented that they found the staff very friendly and approachable and they found the quality of the dentistry to be excellent. They said explanations were clear and made the dental experience as comfortable as possible.

The practice was providing care which was effective and caring, in accordance with the relevant regulations. However we found that this practice was not always providing safe and well led care in accordance with the relevant regulations.

Our key findings were:

• Staff had received safeguarding and whistleblowing training and knew the processes to follow to raise any concerns.
• There were sufficient numbers of suitably qualified staff to meet the needs of patients.
• Staff had been trained to handle medical emergencies.
• The appointment system met the needs of patients and waiting times were kept to a minimum.
• The practice sought feedback from patients about the services they provided.
• There was a lack of appropriate medicines and life-saving equipment was not readily available.
• The practice did not have a system in place which recorded and analysed significant events and complaints and cascaded learning to staff.
• Staff had undertaken training appropriate to their roles and responsibilities. There was no formal system in place to monitor training.
• There was a concern over the practice’s infection control procedures and the practice was not following published guidance.
• We could not assure ourselves that patient’s care and treatment was planned and delivered in line with evidence based guidelines, and current legislation.
• Patients received clear explanations about their proposed treatment, costs, benefits and risks and were involved in making decisions about it. However there were concerns regarding the consent protocol in operation in the practice.
• Patients were treated with dignity and respect and personal confidentiality was maintained but there were concerns regarding the storage of treatment records.
• The practice had some shortfalls in leadership, however staff felt involved and worked as a team.
• Governance systems were not robust. Clinical and non-clinical audits were not undertaken to monitor the quality of services. Where risk assessments had identified concerns these had not been acted upon.
• Practice policies and procedures had not been reviewed periodically.

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

• Assess, monitor and mitigate the risks to the health and safety of patients, staff and visitors.
• Ensure that the premises used by the service provider are safe to use for their intended purpose and are used in a safe way.
• Ensure that the equipment used by the service provider for providing care and treatment to a patient is safe for such use and is used in a safe way.
• Ensure that systems are in place for assessing the risk of, and preventing, detecting and controlling the spread of, infections, including those that are health associated.
• Ensure there is an effective approach for identifying where quality and/or safety is being compromised and steps are taken in response to issues. These include all audits and risk assessments undertaken within the practice.
• Establish systems to support communication about the quality and safety of services and what actions have been taken as a result of audits, concerns, complaints and compliments.
• Ensure that audit processes function well and have a positive impact in relation to quality governance, with clear evidence of actions to resolve concerns.
• Establish processes to actively seek the views of patients and should be able to provide evidence of how they have taken these views into account in relation to decisions.

You can see full details of the regulation not being met at the end of this report.

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

• Establishing systems which monitor that all staff members receive appropriate support, training and supervision necessary for them to carry out their duties.

• Ensuring that all policies and procedures for the practice are periodically reviewed and reflect the protocols in place in the practice.
• Ensuring that all equipment checks are performed as required and records kept of these.
• Reviewing procedures for storage of paper records in accordance with the Department of Health's code of Practice for Records Management (NHS Code of Practice 2006) and other relevant guidance about information security and governance.
• Clearly defining job roles and delegating staff relevant responsibilities to involve all staff in the governance framework.

We spoke with a range of people about the service they received. They included dentists, the Practice Manager, Dental Nurses, and people who used the service.

People we spoke with during the inspection told us they were very satisfied with the care provided and they saw their dentist regularly. They told us the service they received was very good.

People said that the dentist always explained what he was planning to do, what he had found during examination and what the treatment options were. One person told us, “I am more than satisfied with the dental care.”

We saw staff being friendly, respectful and polite when speaking to people. People told us they found staff approachable and supportive. One person said, “The staff are welcoming and the care excellent”.

The practice facilities were clean and maintained. People were protected from the risk of infection because staff used protective clothing and carried out procedures safely.

Staff received regular training and support and were qualified, skilled and experienced. They told us they felt very well supported and valued in their work.

People told us that they were very happy with the service provided. They felt they were given enough information about their treatment options. The practice was clean and staff were knowledgeable and up to date with practice.

A patient told us, “Everyone here is very pleasant and friendly.”

“Treatment is always explained to me so I know what is going on.”

“You can easily see what things will cost.”