We carried out an announced comprehensive inspection of this service on 25 February 2016 as part of our regulatory functions where a breach of legal requirements was found. 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.

We followed up on our inspection of 25 February 2016 to check that the practice had implemented their plan and to confirm that they now met the legal requirements. We carried out a desk based review on 6 July 2016 to check whether the practice had taken action to address a breach of Regulation 17(1), (2) (a) and (b) (d) (ii) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

This report only covers our findings in relation to those requirements. We have not revisited Mr. Pravinkumar P Nana - Winlaton practice for this review because the registered provider was able to demonstrate that they were meeting the standards without the need for a visit.

Our findings were:

Are services well-led?

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

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Mr. Pravinkumar P Nana – Winlaton on our website at www.cqc.org.uk.

We carried out an announced comprehensive inspection on 25 February 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

The practice is owned by Mr. Pravinkumar P Nana. The practice is located on the first floor of the building. There is a combined reception and waiting area, a washroom, and surgery and decontamination room. The practice offers primary care dentistry under the NHS, and private dental care.

The practice is open Monday to Thursday 9am to 5.00pm and Friday 9am to 4pm.

There is a dentist and dental nurse at the practice.

The principal dentist Mr. Pravinkumar P Nana 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 spoke with the dentist and a dental nurse.

On the day of inspection we received four CQC comment cards providing feedback. The patients who provided feedback were positive about the care and attention to treatment they received at the practice. They found the staff to be polite and professional. The practice was clean and tidy.

Our key findings were:

• There was an effective complaints system.
• There were sufficient numbers of suitably qualified staff to meet the needs of patients.
• Patient care and treatment was planned and delivered in line with evidence based guidelines and current regulations.
• Patients received clear explanations about their proposed treatment, costs, benefits and risks, and were involved in making decisions about it.
• Patients were treated with dignity and respect and confidentiality was maintained.
• Patients could access routine treatment and urgent care when required.

Staff felt involved and supported and worked well as a team.

• The practice sought feedback from staff and patients about the services they provided in order to make improvements where needed.

We identified regulations that were not being met and the provider must:

• Ensure the training, learning and development needs of staff members are reviewed at appropriate intervals and an effective process is established for the on-going assessment, appraisal and supervision of all staff employed.
• Ensure dental care records are maintained appropriately giving due regard to guidance provided by the Faculty of General Dental Practice (FGDP) regarding clinical examinations and record keeping.
• Ensure the practice has protocols for recording within the patients’ dental care records the justification for taking the X-ray and the grade and reporting of the X-ray 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 all audits have documented learning points and the resulting improvements can be demonstrated.
• Ensure the practice implements the required actions of Legionella risk assessments giving 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’

• Ensure an effective system is established to assess, monitor and mitigate the various risks arising from undertaking of the regulated activities.

• Ensure the practice implements protocols to maintain securely such other records as are necessary to be kept in relation to the management of the regulated activity.

You can see full details of the regulations not being met at the end of this report.

There was an area where the provider could make improvements and should:

• Review availability of equipment to manage medical emergencies giving due regard to guidelines issued by the Resuscitation Council (UK) standards for the dental team.

• Review the practice’s safeguarding policy; ensuring it covers both children and adults and all staff are trained to an appropriate level for their role and aware of their responsibilities.

• Review the practice’s protocols for the use of rubber dam for root canal treatment giving due regard to guidelines issued by the British Endodontic Society.

• Review the current decontamination processes and techniques giving 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'.

People who used the service were positive about the care and support provided. Comments included “The dentist is good. He is very patient” and “I have been to other dentists and they are not as good as this one”.

People were given all the information they needed to make an informed decision about their care and were asked to provide their consent to such care.

We saw people were cared for effectively and care was planned for the individual.

We saw systems were in place to protect people from the risk of infection.

Staff received support from the provider and were suitably trained and experienced for the role.

The provider had an effective system in place to record and monitor complaints. Complaints were taken seriously and responded to appropriately.