We carried out a follow up inspection on 6 March 2018 at Mr Crawford Black – Church Road.

On 3 January 2018 we undertook an announced comprehensive inspection of this service as part of our regulatory functions. During this inspection we found breaches of the legal requirements.

A copy of the report from our comprehensive inspection can be found by selecting the 'all reports' link for Mr Crawford Black – Church Road 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 Mr Crawford Black – Church Road on 6 March 2018 to confirm whether they had followed their action plan and to check whether they now met the legal requirements in the Health and Social Care Act 2008 and associated regulations. We carried out this announced inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions.

We reviewed the practice against oneof 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

Mr Crawford Black – Church Road is close to the centre of Bebington and provides dental care and treatment to adults and children on an NHS and privately funded basis.

There is one step at the front entrance to the practice. Car parking is available near the practice. The practice has four treatment rooms.

The dental team includes a principal dentist, an associate dentist, a dental hygienist, four dental nurses, and two receptionists. The team is supported by a practice manager, who is also a registered dental nurse.

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 dentists, dental nurses, receptionists and the practice manager. We looked at practice policies, procedures and other records about how the service is managed.

The practice is open:

Monday, Tuesday and Thursday 9.00am to 6.00pm,

(Monday and Tuesday from 08.30am by appointment)

Wednesday and Friday 9.00am to 5.00pm.

Our key findings were:

• The provider had improved their recruitment systems.
• The provider had introduced a system for reporting significant events.
• Meetings were scheduled to give staff an opportunity to feedback about the services they provided.
• The provider had improved their systems to help them manage risk.
• The provider had improved their safeguarding processes. Not all staff were trained in safeguarding.
• The provider had limited means in place to monitor the quality of the service.

There were areas where the provider could make improvements and should:

• Review the practice’s systems for assessing, monitoring and mitigating the various risks arising from the undertaking of the regulated activities, specifically in relation to the risk of a member of staff working with patients prior to a Disclosure and Barring Service check result being received.
• Review the practice's protocols for the completion of dental records taking into account the guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.
• Review the practice’s complaint handling procedures, and ensure contact details for NHS England are available should patients wish to contact them if they did not wish to complain to the practice directly or if they were not satisfied with the way the practice dealt with their concerns.
• Review the practice’s audit protocols to ensure mandatory audits, such as radiography,are carried out at regular intervals to help improve the quality of service. Staff should also review the carrying out of non-mandatory audits, such as, dental care record keeping, ensure all audits have documented learning points and action plans, where appropriate, and resulting improvements can be demonstrated.
• Review the practice’s systems for monitoring staff training.

We carried out this announced inspection on 3 January 2018 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 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

Mr Crawford Black – Church Road is close to the centre of Bebington and provides dental care and treatment to adults and children on an NHS and/or privately funded basis.

There is one step at the front entrance to the practice. Car parking is available near the practice. The practice has four treatment rooms.

The dental team includes a principal dentist, an associate dentist, a dental hygienist, four dental nurses, and two receptionists. The team is supported by a practice manager, who is also a registered dental nurse.

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 26 people during the inspection about the services provided. The feedback provided was positive about the practice.

During the inspection we spoke to both dentists, dental nurses, receptionists and the practice manager. We looked at practice policies, procedures and other records about how the service is managed.

The practice is open:

Monday, Tuesday and Thursday 9.00am to 6.00pm, (Monday and Tuesday from 08.30am by appointment)

Wednesday and Friday 9.00am to 5.00pm.

Our key findings were:

• The practice was clean and well maintained.
• The practice had infection control procedures in place which reflected published guidance.
• Staff knew how to deal with emergencies. Appropriate medical emergency medicines and equipment were available.
• 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 management structure. Staff felt involved and worked well as a team.
• The practice asked patients and staff for feedback about the services they provided.
• The practice had arrangements in place to help them manage most risks. Potential risks relating to Legionella and staff Hepatitis B immunisation response had not been fully assessed and acted on.
• The practice had safeguarding processes in place and staff knew their responsibilities for safeguarding adults and children. Some staff had not received training within the recommended time interval.
• The practice did not have effective staff recruitment procedures in place.
• Not all the clinicians followed current guidelines when providing patients’ care and treatment.
• The practice had a procedure in place for dealing with complaints. Contact details for alternative organisations patients could complain to were not readily available.

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.
• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.
• Ensure the specified information is available regarding each person 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 and should:

• Review the practice’s safeguarding policy and staff training ensuring all staff are trained to an appropriate level for their role and aware of their responsibilities.
• Review awareness of current evidence-based clinical guidance in relation to patient recalls, X-rays, the maintenance of good oral health, the use of rubber dam in root canal treatment, and the content of dental care records.
• Review the training, learning and development needs of individual staff members and have an effective process established for the on-going assessment of all staff.
• Review the practice’s complaint handling procedures and ensure contact information for NHS England is provided for patients who do not wish to complain to the practice directly or are not satisfied with the way the practice has handled their complaint.
• Review the practice’s arrangements for communicating information to staff and service users about the quality and safety of the service.

People spoken with who used the service were very positive about the care and treatment they received and spoke highly of the staff. They told us they felt they had enough time

and information to make a decision about their treatment and the dentists talked through all the different treatment options and costs. They also reported that appointments were flexible to meet their needs and the practice was accessible, comfortable and accommodating. Some comments made were;

"A friend recommended this practice to me and I am very pleased with the service I receive the dentist explains everything in detail."

"I have been a patient here for years now and feel I receive an excellent service."

"The surgery is always clean."

"The place is spotless."