We carried out an announced comprehensive inspection of this practice on 8 March 2016. A breach of legal requirements was found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet the legal requirements in relation to good governance.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Milk Dental on our website at www.cqc.org.uk

Our findings were:

Are services well-led?

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

Background

Milk Dental is situated close to the centre of Liverpool in a residential locality. The practice is located in a converted residential property, and comprises a reception and waiting room, two treatment rooms situated on the ground floor, a decontamination room and storage and staff rooms. Parking is available on nearby streets. The practice is accessible to people with impaired mobility but not to wheelchair users.

The practice provides general dental treatment to predominantly NHS patients of all ages with private treatment options available, and is open Monday, Wednesday and Friday 8.45am to 5.15pm, and Tuesday and Thursday 8.45am to 7.00pm.

The practice is staffed by a dentist and three trainee dental nurses at various stages of their training. Two of the nurses share practice manager responsibilities and all three carry out reception duties in addition to nursing.

The principal dentist is registered with the Care Quality Commission 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 were:

• Staff had access to an automated external defibrillator on the premises in accordance with the Resuscitation Council UK and the General Dental Council standards for the dental team.
• The provider had implemented a log to record non-compliances resulting from infection control audits and action taken in response to these.
• A recruitment checklist had been implemented to ensure necessary employment checks were in place for all staff.
• The provider was storing information in respect of persons employed by the practice securely.

We carried out an announced comprehensive inspection on 8 March 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 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

Milk Dental is situated close to the centre of Liverpool in a busy residential locality. The practice is located in a converted residential property, and comprises a reception and waiting room, two treatment rooms situated on the ground floor, a decontamination room and storage and staff rooms. Parking is available on nearby streets. The practice is accessible to people with impaired mobility but not to wheelchair users.

The practice provides general dental treatment to predominantly NHS patients of all ages with private treatment options available, and is open Monday, Wednesday and Friday 8.45am to 5.15pm, and Tuesday and Thursday 8.45am to 7.00pm. The practice is closed for lunch between 1.00pm and 2.00pm.

The practice is staffed by a dentist and three trainee dental nurses at various stages of their training. Two of the nurses share practice manager responsibilities and all three carry out reception duties in addition to nursing.

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.

We received feedback from 13 patients about the service. The 13 CQC comment cards seen reflected positive comments about the staff and the service provided. Patients commented that they found the staff caring, friendly and professional. They had trust and confidence in the dental treatments and said information and explanations from staff were clear and understandable.

Our key findings were:

• The practice recorded and analysed significant events and incidents and received and acted on safety alerts.
• Staff had received some safeguarding training and knew the process to follow to raise any concerns.
• There was an adequate number of suitably qualified staff to meet the needs of patients.
• Staff had been trained to deal with medical emergencies, however some items of emergency equipment were unavailable.
• Premises and equipment were clean, secure and properly maintained, but improvements were needed to the infection prevention and control procedures.
• Patients’ needs were assessed and care and treatment were delivered in accordance with current legislation, standards and guidance.
• Patients received explanations about their proposed treatment, costs, benefits and risks and were involved in making decisions about it.
• Staff were supported to deliver effective care, and opportunities for training and learning were available, but the practice lacked a structured training plan.
• Patients were treated with dignity and respect and their confidentiality was maintained.
• The appointment system met the needs of patients and waiting times were kept to a minimum.
• Services were planned and delivered to meet the needs of patients and reasonable adjustments were made to enable patients to receive their care and treatment.
• The practice took into account patient feedback but no formal system for obtaining feedback from patients or staff was in place.
• Staff were supervised and felt involved and worked as a team.

We identified a regulation that was not being met and the provider must:

• Ensure the risks to the health, safety and welfare of patients, staff and others are mitigated by providing adequate equipment to manage medical emergencies, having due regard to guidelines issued by the British National Formulary, the Resuscitation Council UK, and the General Dental Council standards for the dental team.
• Ensure systems are established and operated effectively in relation to the recruitment process to ensure the necessary employment checks are in place for all staff, and the required specified information in respect of persons employed by the practice is retained, in accordance with Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
• Ensure the storage of records relating to people employed is in accordance with current legislation and guidance.
• Ensure infection control audits have documented learning points and improvements can be demonstrated as part of the process of assessing, monitoring and improving the quality and safety of the services provided.

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:

• Review the practice’s safeguarding training and ensure all staff are trained to an appropriate level for their role.
• Review staff awareness of the requirements of the Mental Capacity Act 2005 and ensure all staff are aware of their responsibilities under the Act as it relates to their role.
• Review the storage of products identified under Control of Substances Hazardous to Health Regulations 2002 to ensure they are stored securely.
• Review the practice’s infection control procedures and protocols having due regard to 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.
• Review the current legionella risk assessment in relation to the required actions including the monitoring and recording of water temperatures, having due regard to the 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.
• Review the systems in place to monitor and track the use of prescriptions.
• Review the practice’s legal obligations under the Ionising Radiation Regulations 1999 to notify the Health and Safety Executive.
• Review the training, learning and development needs of staff at appropriate intervals.
• Review the practice’s website to ensure details of the complaints procedure are displayed, and ensure details are provided in the practice leaflet as to the steps people can take should they be dis-satisfied with the outcome of their complaint.
• Review the systems in place for obtaining, analysing and acting on feedback from patients, staff and stakeholders about the quality of care provided.

We spoke with three people that used the service. They all told us they had been very satisfied with the treatment they had received. One person who used the service said “It’s a well run place, very professional.”

All people we spoke to who used the service told us that all treatment options were fully explained by the staff when they visited the dentist. They said the service had been professional, reliable and friendly and that all the dental, nursing and reception staff were very skilled. People told us they gave their consent to treatment and they signed documentation to confirm this. Staff also checked peoples' medical histories and medication on a regular basis. They also told us that fees were explained to them prior to treatment.

When we looked around the practice we saw evidence that the premises were kept clean and tidy. People who used the service told us they always found the service to be well maintained and very clean.

We also saw evidence of effective infection control systems in place and good practice being followed. When we looked at training records we saw evidence that all staff had been professionally trained to the level their positions required and that they had completed training in other appropriate courses. We saw evidence that there was a quality assurance system in place that informed the future performance of the service.

We carried out this unannounced inspection on 13 February 2019 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We planned the inspection on an unannounced basis as we had concerns that the provider may not be meeting the fundamental standards of care laid down 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

Milk Dental is in a residential suburb of Liverpool and provides NHS and private dental care for adults and children.

The practice is accessed via a flight of steps. Car parking is available nearby.

The dental team includes the principal dentist and two dental nurses. The team is supported by a practice manager. The practice has two treatment rooms.

The practice is owned by an individual who is the principal dentist there. They 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 spoke to the provider, the dental nurses and the practice manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday, Wednesday and Friday 8.45am to 5.15pm

Tuesday and Thursday 8.45am to 7.00pm.

Our key findings were:

• The practice was clean.
• The practice had infection control procedures in place. These did not reflect published guidance.
• The provider did not have safeguarding procedures in place.
• Staff knew how to deal with medical emergencies. Medical emergency medicines were out of date and not all the recommended medical emergency equipment was available.
• The provider had staff recruitment procedures in place. The provider did not have all the required recruitment information available.
• The provider took insufficient account of current guidelines when providing patients’ care and treatment.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• The appointment system took account of patients’ needs.
• The provider had a procedure in place for dealing with complaints. This did not contain all the recommended information for patients.
• The provider did not sufficiently demonstrate the leadership skills to deliver quality, sustainable care. Improvements made by the provider following previous inspections were not embedded or sustained.
• The provider had systems in place to manage risk. These were not operating effectively. Several risks had not been identified; others had not been reduced sufficiently.
• Staff felt involved and supported, and worked well as a team.
• The practice did not seek feedback from patients about the services they provided.

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 specified information is available regarding each person employed
• Ensure, where appropriate, persons employed are registered with the relevant professional body.

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 and significant events with a view to preventing further occurrences and ensuring that improvements are made as a result.
• Review the practice’s arrangements for responding to patient safety alerts, recalls and rapid response reports issued by the Medicines and Healthcare products Regulatory Agency, the Central Alerting System and other relevant bodies, such as Public Health England.
• Review the practice's complaint handling procedures. In particular, ensure sufficient information, including contact details for NHS England and the Dental Complaints Service, is available for patients.