We carried out a follow up inspection at Levine & Leslie Dental Surgery on the 8 March 2017.

We had undertaken an announced comprehensive inspection of this service on the 27 April 2016 as part of our regulatory functions where breaches of legal requirements were found.

After the comprehensive inspection, the practice wrote to us to say what they would do to meet the legal requirements in relation to each of the breaches. This report only covers our findings in relation to those requirements.

We reviewed the practice against two of the five questions we ask about services: is the service safe and well led?

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Levine & Leslie Dental Surgery on our website at www.cqc.org.uk.

We revisited the Levine & Leslie Dental Surgery as part of this review and checked whether they had followed their action plan and to confirm they now met the legal requirements.

Our findings were:

Are services safe?

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

Are services well-led?

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

Background

Levine & Leslie Dental Surgery is situated in Leeds, West Yorkshire. It offers only privately funded dental treatments. The services include preventative advice and treatment and routine restorative dental care.

The practice has two surgeries, a waiting area and a reception area. All facilities are of the ground floor of the premises. There are toilet facilities but these are not accessible for wheelchair users.

There is one dentist, one dental hygienist, two dental nurses and one receptionist.

The opening hours are Monday to Friday from 9-00am to 5-30pm.

The practice owner 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:

• An X-ray audit had been completed.
• Staff were up to date with mandatory Continuing Professional Development (CPD).
• A more robust log of antibiotics was now in place and all antibiotics were in date.
• We saw that several materials and local anaesthetics were out of date.
• The Control of Substances Hazardous to Health (COSHH) folder had been updated but still did not reflect all substances held at the practice. COSHH substances were not always held safely.
• We identified antibiotics had been inappropriately prescribed for a patient who had not been clinically examined by a suitably qualified dental professional.

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

• Review the practice’s protocols for the prescribing and recording of antibiotic medicines taking into account guidance provided by the Faculty of General Dental Practice in respect of antimicrobial prescribing.
• Review stocks of medicines and equipment and the system for identifying and disposing of out-of-date stock.
• Review the storage of products identified under Control of Substances Hazardous to Health (COSHH) 2002 Regulations to ensure they are stored securely.

We carried out an announced comprehensive inspection on 27 April 2016 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

Levine & Leslie Dental Surgery is situated in Leeds, West Yorkshire. It offers only private dental treatments. The services include preventative advice and treatment, routine restorative dental care and relative analgesia (conscious sedation using a mixture of nitrous oxide gas and oxygen).

The practice has two surgeries, a waiting area and a reception area. All facilities are of the ground floor of the premises. There are toilet facilities but these are not accessible for those in a wheelchair.

There is one dentist, one dental hygienist, two dental nurses and one receptionist.

The opening hours are Monday to Friday from 9-00am to 5-30pm.

The practice owner 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.

During the inspection we received feedback from 13 patients. The patients were positive about the care and treatment they received at the practice. Comments included that the premises were safe and hygienic and that staff were helpful, friendly and professional. Patients also commented that it was easy to get an appointment.

Our key findings were:

• The practice appeared clean and hygienic.
• The decontamination process was effective and equipment was appropriately validated and serviced.
• Staff had a limited understanding of what a significant event was.
• Several materials and local anaesthetics in the surgeries were out of date.
• There was no stock control system for antibiotics and we found some antibiotics were out of date and had been prescribed to patients recently.
• Staff had a limited understanding of Control of Substances Hazardous to Health 2002 (COSHH) regulations and the COSHH folder did not have several materials recorded in it.
• Staff were qualified and had received training appropriate to their roles.
• Dental care records lacked detail and did not follow Faculty of General Dental Practice guidance.
• Oral health advice and treatment were provided in-line with the ‘Delivering Better Oral Health’ toolkit (DBOH).
• We observed that patients were treated with kindness and respect by staff. Staff ensured there was sufficient time to explain fully the care and treatment they were providing in a way patients understood.
• Patients were involved in making decisions about their treatment and were given clear explanations about their proposed treatment including costs, benefits and risks. This was not documented in the dental care records.
• Patients were able to make routine and emergency appointments when needed.
• The practice did not regularly undertake audits of dental care records or the Infection Prevention Society (IPS) audit.
• The practice did not have any arrangements for seeking feedback from patients.

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

• Ensure systems are in place to assess, monitor and improve the quality of the service such as undertaking regular audits of various aspects of the service and ensuring that where appropriate audits have documented learning points and the resulting improvements can be demonstrated.
• Ensure systems are put in place for the proper and safe management of medicines.
• Ensure staff are up to date with their mandatory training and their Continuing Professional Development (CPD)
• Ensure the availability of medicines and equipment to manage medical emergencies giving due regard to guidelines issued by the British National Formulary and the Resuscitation Council (UK).

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

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

• Review the practice’s system for the recording, investigating and reviewing incidents or significant events with a view to preventing further occurrences and, ensuring that improvements are made as a result.
• Review the practice’s protocol for identifying and disposing of out-of-date stock.
• Review the practice’s waste handling policy and procedure to ensure waste is segregated and disposed of in accordance with relevant regulations giving due regard to guidance issued in the Health Technical Memorandum 07-01 (HTM 07-01).
• Review its responsibilities as regards to the Control of Substance Hazardous to Health (COSHH) Regulations 2002 and, ensure all documentation is up to date and staff understand how to minimise risks associated with the use of and handling of these substances.
• Review whether the practice is compliant with the Pressure Systems Safety Regulations 2000.
• Review the practice’s system for ensuring staff are up to date with their training in relation to the provision of relative analgesia.
• Ensure the dentist has undertaken the appropriate
• Review the arrangement for the zoning of the decontamination area in the hygienist’s room.
• Review the practice’s protocols for recording in the patients’ dental care records or elsewhere the reason for taking the X-ray and quality of the X-ray giving due regard to the Ionising Radiation (Medical Exposure) Regulations (IR(ME)R) 2000.
• Review the protocols and procedures for use of X-ray equipment giving due regard to Guidance Notes for Dental Practitioners on the Safe Use of X-ray Equipment.
• Review the practice's protocols for completion of dental records giving due regard to guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.
• Review the practice’s arrangement for seeking feedback from patients.
• Review the arrangement for the documentation of practice meetings.

We spoke with four people who used the service. They were complimentary about the practice and the care and treatment they received. One person said that the dentist was “Extremely thorough and caring. Another told us that their “Treatment has been excellent.” They all felt that the staff were friendly and that they were made welcome when they attended the practice. They also said that they could usually get an appointment when they wanted. One person said they would like the practice to stay open late one evening for people who worked full time.

We found that the staff were respectful and courteous. Patients had their dental needs assessed when they visited the practice and were given advice on oral hygiene. People told us that the dentist explained the treatment options available to them and they felt fully involved in decisions about their care and treatment.

The practice had, as far as it was reasonably practicable, made arrangements to protect people from the risks of healthcare associated infections. The practice actively sought the views of people who used the service. The practice had not received any formal complaints in the last two years but had a policy on display on the notice board in the reception area describing how complaints would be handled.