We carried out an announced responsive follow up inspection on 19 January 2017 to ask the practice the following key questions; Are services safe and are they well-led?

We had undertaken an announced comprehensive inspection of this service on 26 April 2016 as part of our regulatory functions where breaches of legal requirements were found.

Our findings were:

Are services safe?

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

Are services well-led?

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

Background

Lime Tree Dental Practice is a wholly private practice offering a family service with a breadth of dentistry and a membership payment scheme. It is a detached suburban property situated near the centre of Portishead with roadside parking. The practice has a ramp to the front door to enable access for patients with mobility needs, a ground floor reception and surgery facilities. There is a patient toilet on the ground floor but due to building constraints it is not accessible to wheelchair users.

There are two waiting rooms, two treatment rooms, one on the ground floor and one on the first floor.

The practice has a team of five dentists with a variety of expertise and patients may see different dentists for different parts of their treatment.

The practice has a principal dentist / provider who is registered as an individual provider. A registered provider is a ‘registered person’ who is registered with the Care Quality Commission to run the service. 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.

The practice is open Monday, Tuesday and Friday 8.30am to 5.00pm; Wednesday 8.30am to 2.00pm offering lunchtime appointments; Thursday 8.30am to 7.00pm; Friday 8.30am to 5.00pm. Some Saturday appointments were offered according to patient need. For emergency and out of hour’s assistance contact information is available from the practice telephone answering service.

We reviewed 56 CQC comment cards that had been left for patients to complete, prior to our visit, about the services provided. In addition we spoke with seven patients on the day of our inspection. Feedback from patients was positive about the care they received from the practice. They commented staff put them at ease, listened to their concerns and provided an excellent service in which they had confidence in the dental care provided.

Our key findings were:

• The patients we spoke with indicated they were treated with kindness and respect by staff and received good care in a clean environment from a helpful practice team. We observed good communication with patients and their families.
• Premises appeared well maintained and visibly clean. Good cleaning and infection control systems were in place. The treatment rooms were well organised and equipped, with good light and ventilation
• The practice was meeting the Essential Quality Requirements of the Department of Health guidance, namely 'Health Technical Memorandum 01-05 - Decontamination in primary care dental practices (HTM 01-05)' national guidance for infection prevention control in dental practices.
• The dental practice had effective clinical governance and risk management processes in place; including health and safety and the management of medical emergencies. There were systems in place to learn and improve from incidents or healthcare alerts.
• The practice had a comprehensive system to monitor and continually improve the quality of the service; including through a detailed programme of clinical and non-clinical audits.
• There were systems in place to check all equipment had been serviced regularly, including the air compressor, autoclave, fire extinguishers, oxygen cylinder and the X-ray equipment.
• Appropriate recruitment processes and checks were undertaken in line with the relevant recruitment regulations and guidance for the protection of patients.
• There were sufficient numbers of suitably qualified staff who maintained the necessary skills and competence to support the needs of patients.
• Staff were supported to maintain their continuing professional development; had undertaken training appropriate to their roles and felt supported in their work.
• The practice had an empowered practice manager who provided accessible and visible leadership and clear means of sharing information with staff. Staff were up to date with current guidelines and supported in their professional development.

We carried out an announced comprehensive inspection on 26 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 this practice was not providing safe care in accordance with the relevant regulations.

Are services effective?

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

Are services caring?

We found this practice was providing caring services in accordance with the relevant regulations.

Are services responsive?

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

Are services well-led?

We found this practice was not providing well-led care in accordance with the relevant regulations.

Background

Lime Tree Dental Practice is a wholly private practice offering a family service with a breadth of dentistry and a membership payment scheme. It is a detached suburban property situated near the centre of Portishead with roadside parking. The practice has a ramp to the front door to enable access for patients with mobility needs, a ground floor reception and surgery facilities. There is a patient toilet on the ground floor but due to building constraints it is not accessible to wheelchair users.

There are two waiting rooms, two treatment rooms, one on the ground floor and one on the first floor.

The practice has a team of five dentists with a variety of expertise and patients may see different dentists for different parts of their treatment. The practice has a principal dentist / provider Jonathan Jones who is registered as an individual provider. A registered provider is a ‘registered person’ who is registered with the Care Quality Commission to run the service. 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.

The practice is open Monday, Tuesday and Friday 8.30am to 5.00pm; Wednesday 8.30am to 2.00pm offering lunchtime appointments; Thursday 8.30am to 7.00pm; Friday 8.30am to 5.00pm. Some Saturday appointments were offered according to patient need. For emergency and out of hour’s assistance contact information is available from the practice telephone answering service.

We reviewed 56 CQC comment cards that had been left for patients to complete, prior to our visit, about the services provided. In addition we spoke with seven patients on the day of our inspection. Feedback from patients was positive about the care they received from the practice. They commented staff put them at ease, listened to their concerns and provided an excellent service in which they had confidence in the dental care provided.

Our key findings were:

• The practice carried out oral health assessments and planned treatment in line with current guidance, for example from the Faculty of General Dental Practice (FGDP). Patient dental care records were detailed and showed on-going monitoring of patients oral health.

• Patients commented they felt involved in their treatment and that it was fully explained to them. We reviewed 56 CQC comment cards completed by patients. Common themes were patients felt they received very good care in a clean environment from a helpful practice team. We observed good communication with patients and their families, access to the service and to the dentists, was good.

• The practice had an efficient appointment system in place to respond to patient’s needs. Patients reported good access to the practice with emergency appointments available within 24 hours. There were clear instructions for patients regarding out of hours care.

• There were systems to check equipment had been serviced regularly, including the compressor, autoclave, fire extinguishers, oxygen cylinder and the X-ray equipment.

• The practice was not meeting the Essential Quality Requirements of the Department of Health guidance, namely 'Health Technical Memorandum 01-05 - Decontamination in primary care dental practices (HTM 01-05)' national guidance for infection prevention control in dental practices. There was no clear designated lead professional for infection prevention and control.

• The management of sharps was not in accordance with the current EU regulations with respect to safer sharps (Health and Safety Sharp instruments in Healthcare Regulations 2013). However the provider took immediate action to comply with this regulation.

• Staff were supported to maintain their continuing professional development; had undertaken training appropriate to their roles and reported they felt well supported in their work. There were robust systems in place to learn and improve from incidents or healthcare alerts.

• There was no evidence of any recent audits being undertaken at the dental practice to monitor and continually improve the quality of the service through a detailed audit programme.

• Appropriate recruitment processes and checks were not undertaken in line with the relevant recruitment regulations and guidance for the protection of patients.

• The dental practice had some clinical governance and risk management processes in place; however they were not wholly effective and lacked some attention to detail to ensure compliance with the relevant regulations.

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

• Ensure the practice’s infection control procedures and protocols are suitable taking into account guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices and The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance.

• Ensure an effective system is established to assess, monitor and mitigate the various risks arising from undertaking of the regulated activities in a timely way.

• Ensure the practice's recruitment policy and procedures are suitable and the recruitment arrangements are in line with Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 to ensure necessary employment checks are in place for all staff and the required specified information in respect of persons employed by the practice is held.

People that we spoke with on the day of our visit told us that their dentist explained treatment options to them and provided information about the costs that would be involved. We were told that people could make appointments easily and were happy overall with the service provided.

We saw that people were invited to provide feedback on the service and there was a complaints procedure in place should people wish to raise concerns.

Staff were knowledgaable in relation to their responsibility to safeguard children and vulnerable adults and there were policies in place to support them.

We saw that there were procedures in place for the sterilisation of dental instruments and these met with the requirements of the HTM 01-05 (Health Technical Memorandum). This is the guidance that all dentists must follow to ensure that their practice is safe and minimises the risks of cross infection.