We carried out a follow-up inspection at Maltby Dental Practice on the 16 October 2017.

We had undertaken an announced comprehensive inspection of this service on the 26 May 2017 as part of our regulatory functions where a breach of legal requirements was found.

After the comprehensive inspection, the registered manager wrote to us to say what they would do to meet the legal requirements in relation to the breach. This report only covers our findings in relation to that requirement.

We reviewed the practice against one of the five questions we ask about services: are the services well led? You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Maltby Dental Practice on our website at www.cqc.org.uk.

We revisited Maltby Dental Practice as part of this review and checked whether they had followed their action plan and to confirm that they now met the legal requirements. We carried out this announced inspection on 16 October 2017 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 supported by a specialist dental adviser.

• Is it well-led?

This question forms the framework for the areas we look at during the inspection.

Our findings were:

Are services well-led?

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

Background

Maltby dental practice is located in Maltby, Rotherham and is part of the P B Robinson and associates corporate business and provides NHS and private treatment to patients of all ages.

Entry into the practice is by step access from the main street. At the rear of the building there is level access for people who use wheelchairs. Car parking spaces are available nearby on local roads.

The dental team includes one dentist, one dental nurse, one receptionist and a visiting group practice manager. The practice has two treatment rooms, an X-ray room and a decontamination room.

The practice is owned by a company and as a condition of registration must have a person registered with the Care Quality Commission as the registered manager. Registered managers 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 registered manager at Maltby Dental Practice is the group practice manager.

During the inspection we spoke with the dentist, the group practice manager and the group clinical director. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday – Thursday 9.00am – 5.30pm, Friday 9.00am – 3.00pm:

Our key findings were:

• Effective management of medicines and life-saving equipment was now in place, a minor improvement was required to monitor and record the temperature of the medicine fridge.
• The practice’s incident reporting processes were now effective.
• The practice had implemented systems to help them manage risk; we found risk assessments associated with Control of Substances Hazardous to Health (COSHH) required minor improvement.
• The clinical staff provided patients’ care and treatment in line with current guidelines.
• Prescription pad security and was now effective.
• The practice’s quality assurance processes were now in place.
• X-ray justification and quality assurance was ongoing with improvement being monitored regularly.

There were areas where the provider could make improvements. They should:

• Review the practice's policy and the storage of products identified under Control of Substances Hazardous to Health (COSHH) 2002 Regulations to ensure a risk assessment is undertaken.
• Review the storage of emergency medicines requiring refrigeration to ensure they are stored in line with the manufacturer’s guidance and if stored in the fridge that the temperature is monitored and recorded.

We carried out this announced inspection on 26 May 2017 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 supported by a specialist dental adviser.

We told the NHS England area team and Healthwatch that we were inspecting the practice. They provided information about the practice which we took into account.

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

Maltby dental practice is located in Maltby, Rotherham and is part of the P B Robinson and associates corporate business and provides NHS and private treatment to patients of all ages.

Entry into the practice is by step access from the main street. At the rear of the building there is level access for people who use wheelchairs. Car parking spaces are available nearby on local roads.

The dental team includes one dentist, one dental nurse, one receptionist and a visiting group practice manager. The practice has two treatment rooms, an X-ray room and a decontamination room.

The practice is owned by a company and as a condition of registration must have a person registered with the Care Quality Commission as the registered manager. Registered managers 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 registered manager at Maltby dental is the group practice manager.

On the day of inspection we collected one CQC comment card filled in by a patient and spoke with two other patients. This information gave us a positive view of the practice.

During the inspection we spoke with one dentist, one dental nurse, one receptionist, the group practice manager and the group clinical director. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday – Thursday 9.00am – 5.30pm, Friday 9.00am – 3.00pm

Our key findings were:

• The practice was clean and suitably maintained.

• The practice had infection control procedures which reflected published guidance.

• Staff knew how to deal with emergencies. Management of medicines and life-saving equipment was not robust.

• The practice’s incident reporting processes could be improved.

• The practice had systems to help them manage risk but improvement was required.

• The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.

• The practice had thorough staff recruitment procedures.

• The clinical staff generally provided patients’ care and treatment in line with current guidelines but could be improved.

• Staff treated patients with dignity, respect and took care to protect their privacy and personal information.

• The appointment system met patients’ needs.

• Prescription pad security was not effective.

• Management and clinical effectiveness could be improved. Staff felt involved and supported and worked well as a team.

• The practice’s quality assurance processes were not effective.

• The practice asked staff and patients for feedback about the services they provided.

• The practice had processes in place to deal with complaints positively.

We identified regulations the provider was not meeting. They must:

• Ensure the practice’s sharps handling procedures and protocols comply with the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.

• Ensure the practice has availability of equipment to manage medical emergencies and take into account guidelines issued by the Resuscitation Council (UK), and the General Dental Council (GDC) standards for the dental team.

• Ensure the practice’s protocols for recording in the patients’ dental care records or elsewhere the reason for taking the X-ray, the quality of the X-ray and a report on the findings giving due regard to the Ionising Radiation (Medical Exposure) Regulations (IR(ME)R) 2000.

• Ensure audits of various aspects of the service, such as radiography are undertaken at regular intervals to help improve the quality of service. Practice should also ensure, that where appropriate audits have documented learning points and the resulting improvements can be demonstrated.

Full details of the regulations the provider was not meeting are at the end of this report.

There were areas where the provider could make improvements. They should:

• Review the practice’s system for 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 arrangements for receiving and responding to patient safety alerts, recalls and rapid response reports issued from the Medicines and Healthcare products Regulatory Agency (MHRA) and through the Central Alerting System (CAS), as well as from other relevant bodies, such as Public Health England (PHE).

• Review its responsibilities as regards the Control of Substances 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 and handling of these substances.

• Review the practice’s protocols for the use of rubber dam for root canal treatment taking into account guidelines issued by the British Endodontic Society.

• Review the security of prescription pads in the practice and ensure there are systems in place to track and monitor their use.

• Review the practice’s current Legionella risk assessment and implement the required actions taking into account guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices and have regard to The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance.’

• Review the practice's protocols for completion of dental care records taking into account guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.

• Review current policies and procedures for obtaining patient consent to care and treatment and ensure they reflect current legislation and guidance, and that staff follow them at all times.

We spoke with two people who used the service. They spoke positively about the care and treatment they had received. They told us the treatments were clearly explained and the staff were very good. One person told us, “It is a fantastic service I cannot fault it, the dentist has been brilliant.” We also looked at the quality monitoring questionnaires and some comments were; "Staff are always very friendly and willing to help." "Nice friendly service." and "Excellent, was very nervous but staff put me at ease."

Evidence showed people were protected from the risk of infection because appropriate guidance had been followed. People we spoke with told us the practice was always clean although the décor was tired and required some redecoration.

We saw that appropriate checks were undertaken before staff began work. Staff received appropriate professional development. Records and staff comments demonstrated they had received various training to enable them to meet people's needs.

The practice had an effective well organised system to regularly assess and monitor the quality of service that people received. The practice had a complaints policy and took account of complaints and comments to improve the service. People we spoke with told us they were regularly asked to give feedback in the form of questionnaires. We also saw the results of the questionnaires carried out over the last year, which were mostly positive.