We carried out this announced inspection on 25 March 2019 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.

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 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

Maggie's Independent Dental Hygiene Service (MIDHS) is in Mossley and provides private treatment to adults and children. This is primarily a dental hygiene service, with a routine dentistry provision one day a week. In addition, the service offers advanced restorative treatments and conscious sedation.

There is single step access into the practice. Car parking spaces are available near the practice.

The dental team includes, two dental hygienists (one of whom is the provider and senior dental hygienist), one dentist, two dental nurses and the practice manger/receptionist. On an ad-hoc basis the practice is visited by a dentist who has a special interest in restorative dentistry and a dentist who has a special interest in the provision of conscious sedation. The practice has one treatment 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 MIDHS is senior provider.

On the day of inspection, we collected 26 CQC comment cards filled in by patients, all of which were complimentary about the service being provided.

During the inspection we spoke with the provider, one dental nurse and the practice manager. We looked at practice policies and procedures and other records about how the service is managed. Patients were not booked in for appointments during the inspection.

The practice is open: Monday, Wednesday and Thursday 9am to 5pm

Tuesday 9am to 7pm and Friday 9am to 4pm.

Our key findings were:

• The practice appeared clean and well maintained.
• The provider had infection control procedures which reflected published guidance.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• Improvements could be made to manage risk to patients and staff, in particular materials identified as hazardous to health and response to risk assessment recommendations.
• Systems were not in place to ensure conscious sedation was carried out in line with guidance.
• Systems to ensure appropriate training and qualifications were up-to date in respect to the provision of conscious sedation were not in place.
• The provider had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
• Recruitment procedures were in place, the process to review appropriate staff checks was not effective.
• Improvements could be made to ensure staff training was undertaken in a timely manner.
• Systems for recording, investigating and reviewing incidents or significant events were not embedded.
• Except for one area relating to antimicrobial prescribing, 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.
• Staff were providing preventive care and supporting patients to ensure better oral health.
• The appointment system took account of patients’ needs.

• The provider could improve their leadership of the practice to ensure full oversight of systems and processes taking place out of their field of expertise.

• The practice culture of continuous improvement could be improved.
• Staff felt involved and supported and worked well as a team.
• The provider asked staff and patients for feedback about the services they provided.
• The provider dealt with complaints positively and efficiently.
• The provider had suitable information governance arrangements.

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

• Ensure care and treatment is provided in a safe way to patients.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.

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 protocols to ensure clinical staff remain up-to-date with guidance issued by the Faculty of General Dental Practice. In particular; antimicrobial prescribing.
• Review staff training to ensure that dental nursing staff who assist in conscious sedation have the appropriate training and skills to carry out the role. In addition, ensure all staff participating in conscious sedation have undertaken an appropriate level of life support training taking into account guidelines published by The Intercollegiate Advisory Committee on Sedation in Dentistry in the document 'Standards for Conscious Sedation in the Provision of Dental Care 2015.
• 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 policy for the control and storage of substances hazardous to health identified by the Control of Substances Hazardous to Health Regulations 2002, to ensure risk assessments are undertaken.

We undertook a follow up inspection to MIDHS on 25 March 2014 to see what action the registered provider had taken to become compliant. We did not speak with people who used the service during this inspection.

We found that since our last inspection the registered provider had ensured, that all existing staff working at the practice and who have direct contact with both children and adults, had received an enhanced Criminal Record Bureau check.

Evidence was available to demonstrate that the registered provider, who is also the registered manager of the service, had ensured that all appropriate documentation was now in place for each member of the staff employed at the practice.

At the time we visited MIDHS no people had appointments arranged and we could not, therefore, gain any direct views from people using the service. We did however have access to twelve recently completed questionnaires by people following their treatment. All were extremely complimentary about the service.

We found the premises to be clean and hygienic with systems in place to monitor the standards of infection control and general service delivery.

Although each member of staff working at the practice had an individual personnel file, not all the required paperwork was in place or available.