We carried out a follow up inspection on 10 November 2017 at Mouthmatters.

On 30 August 2017 we undertook an announced comprehensive inspection of this service as part of our regulatory functions. During this inspection we found a breach of the legal requirements.

A copy of the report from our comprehensive inspection can be found by selecting the 'all reports' link for Mouthmatters on our website at www.cqc.org.uk.

After the comprehensive inspection, the practice 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 those requirements.

We revisited Mouthmatters on 10 November 2017 to confirm whether they had followed their action plan, and to confirm that they now met the legal requirements in the Health and Social Care Act 2008 and associated regulations. We carried out this unannounced inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions.

We reviewed the practice against one of the five questions we ask about services: is the service well-led?

The inspection was led by a CQC inspector who was supported by a specialist dental adviser.

Our findings were:

Are services

well-led

?

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

Background

Mouthmatters is close to the centre of Chester and provides dental care and treatment to adults and

children on a privately funded basis.

There is a small step at the front entrance to the practice. The provider has a portable ramp available to facilitate access to the practice for wheelchair users. The practice has three treatment rooms. Car parking is available nearby.

The dental team includes a principal dentist, a dental hygienist, two dental nurses, one of whom is also the treatment co-ordinator, and a receptionist. The team is supported by an external practice management consultant. Several specialist dentists provide services at the practice when required.

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 principal dentist, one of the dental nurses and the receptionist.

We looked at practice policies, procedures and other records about how the service is managed.

The practice is open:

Monday to Friday 8.30am to 5.00pm.

Our key findings were:

• The practice now had effective systems in place in relation to recruitment, radiation, infection control, and stock control of medicines and dental materials, including medical emergency medicines.
• The practice had a leadership structure in place. Staff felt involved and worked well as a team.
• The practice operated robust infection control procedures which reflected published guidance.
• The practice had improved their systems in place to help them identify and manage risk. Risks associated with fire, used sharps and Legionella had been reasonably reduced.

We found that people's views and experiences were taken into account and people were given the information they needed to make a decision about their treatment. We spoke to one person who used the service. They told us they were given appropriate information and support regarding their treatment options and costs. They were very positive about the care and treatment they received.

Surveys to find out people’s views were undertaken by the service. We looked at sixteen surveys completed in 2011 and 2012. We found that people were happy with the service being provided. All considered that staff were friendly and helpful and that procedures and costs were explained. We found that clear records were maintained of people's medical history and treatment plans. There was a clear system for patient re-call. This ensured that people's health care needs were appropriately supported.

Staff had received guidance in safeguarding the welfare of children and vulnerable adults. This showed that the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

We found that people were protected from the risk of infection because appropriate guidance was being followed. A person who used the service and the results from surveys indicated that the service was clean.

We found that there were systems in place to monitor the quality of the service provided. This ensured that people benefitted from a safe and effective service.

We carried out this announced inspection on 30 August 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 Cheshire and Merseyside area team and Healthwatch that we were inspecting the practice. We did not receive any information of concern from them.

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

Mouthmatters is close to the centre of Chester and provides dental care and treatment to adults and children on a privately funded basis.

There is a small step at the front entrance to the practice. The provider has a portable ramp available to facilitate access to the practice for wheelchair users. The practice has three treatment rooms. Car parking is available near the practice.

The dental team includes a principal dentist, a dental hygienist, two dental nurses, one of whom is the treatment co-ordinator, and a receptionist. The team is supported by an external practice management consultant. Several specialist dentists provide services at the practice when required.

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.

We received feedback from 15 people during the inspection about the services provided. The feedback provided was positive about the practice.

During the inspection we spoke to the principal dentist, the dental hygienist, one of the dental nurses, the receptionist and the practice management consultant. We looked at practice policies, procedures and other records about how the service is managed.

The practice is open:

Monday to Friday 8.30am to 5.00pm.

Our key findings were:

• The practice was clean and well maintained.
• The practice had safeguarding processes in place and staff knew their responsibilities for safeguarding adults and children.
• Staff provided patients’ care and treatment in line with current guidelines.
• The practice had a procedure in place for dealing with complaints.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• The appointment system took patients’ needs into account. Dedicated emergency appointments were available.
• The practice had a leadership structure. Staff felt involved and supported and worked well as a team.
• The practice asked patients and staff for feedback about the services they provided.
• The practice had infection control procedures in place which reflected published guidance, except in relation to re-processing of unused instruments, and storage.
• Staff knew how to deal with emergencies. Not all the recommended medical emergency medicines and equipment were available.
• The practice had systems in place to help them manage risk but risks associated with fire, used sharps and Legionella had not all been reasonably reduced.
• The practice had staff recruitment procedures in place but not all the required information was available in staff recruitment records.

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

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

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 and should:

• Review the practice’s arrangements for responding to patient safety alerts, recalls and rapid response reports issued from the Medicines and Healthcare products Regulatory Agency and through the Central Alerting System, as well as from other relevant bodies such as, Public Health England.
• Review the practice’s system for identifying and disposing of out-of-date stock.
• Review the practice’s protocols and procedures to ensure staff are up to date with their recommended training and their continuing professional development.
• Review the protocols and procedures in relation to the safe use of X-ray equipment taking account of the relevant guidance notes, specifically in relation to the appointment of a Radiation Protection Adviser and the use of collimation.