We carried out a focused inspection of Mr Steven Alan Jepson – Blackpool on 27 June 2018.

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

We undertook a comprehensive inspection of Mr Steven Alan Jepson – Blackpool on 24 January 2018 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We found the registered provider was providing safe, effective, caring and responsive care in accordance with relevant regulations. We judged the practice was not providing well-led care in accordance with Regulation 17 ‘good governance’ of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can read our report of that inspection by selecting the 'all reports' link for Mr Steven Alan Jepson – Blackpool on our website www.cqc.org.uk.

We undertook a follow up focused inspection of Mr Steven Alan Jepson – Blackpool on 27 June 2018. This inspection was carried out to review in detail the actions taken by the practice to improve the quality of care and to confirm that the practice was now meeting legal requirements.

When one or more of the five questions is not met we require the service to make improvements and send us an action plan. We then inspect again after a reasonable interval, focusing on the area where improvement was required.

At this focused inspection we asked the question

• Is it well-led?

This question forms the framework for the area we look at during the inspection.

Our findings were:

Are services well-led?

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

The provider had made improvements to put right the concerns identified and deal with the regulatory breach we found at our inspection on 24 January 2018.

Background

Mr Steven Alan Jepson – Blackpool is in centre of Blackpool and provides NHS and private treatment to adults and children.

There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces are available near the practice.

The dental team includes 12 dentists, 19 dental nurses, two dental hygienists, one dental hygiene therapist and four receptionists. The team is supported by a practice manager. The practice has 13 treatment rooms.

The practice is owned by an individual who is the principal dentist and a partner 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 with the practice manager. We looked at practice policies and procedures and other records about how the service has made improvements to meet the requirement notice served in January 2018.

Our key findings were:

• The practice had developed infection control procedures which reflected published guidance.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• The practice had reviewed systems to help them manage risk.
• The practice had introduced thorough staff recruitment procedures.
• The practice had developed their leadership and culture of continuous improvement.
• The practice asked staff and patients for feedback about the services they provided.

We carried out this announced inspection on 24 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 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

SA Jepson King Street Dental practice is in north Blackpool and provides NHS and limited private funded treatment to both adults and children.

There is level access for people who use wheelchairs and pushchairs. Car parking spaces are available near the practice in a pay and display car park.

The dental team includes 13 dentists, 19 dental nurses, two dental hygienists, one dental hygiene therapist and four receptionists. The team is supported by a practice manager. The practice has 13 treatment rooms.

The practice is registered as 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.

On the day of inspection we collected 30 CQC comment cards filled in by patients. This information gave us a positive patient view of the practice.

During the inspection we spoke with two dentists, one dental nurse, two receptionists 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 to Friday 8.30am – 5.30pm and alternate Thursdays until 6.30pm

Our key findings were:

• The practice was clean.
• The practice had infection control procedures which reflected published guidance.
• The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• 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.
• Patients reported they felt happy with the treatment they received.
• The appointment system met patients’ needs.
• The practice dealt with complaints positively and efficiently.
• Sedation services offered by the practice did not meet current guidelines.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were not easily accessible.
• The practice had limited systems to help them manage risk.
• The practice did not have thorough staff recruitment procedures.
• The practice lacked effective leadership.
• The practice did not actively ask staff and patients for feedback about the services they provided.

We identified a regulation 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 regulation the provider was not meeting are at the end of this report.

There were areas where the provider could make improvements. They should:

• Establish an effective process for the ongoing monitoring of training, learning and development needs of individual staff members at appropriate intervals to ensure staff are up to date with their training and their Continuing Professional Development (CPD).
• Review availability of medicines and equipment to manage medical emergencies taking into account guidelines issued by the British National Formulary, the Resuscitation Council (UK), and the General Dental Council (GDC) standards for the dental team.
• Review the practice's policy and the information available of products identified under Control of Substances Hazardous to Health (COSHH) 2002 Regulations to ensure a risk assessment is undertaken and up to date data sheets are available.
• Review the processes and systems in place for seeking and learning from patient feedback with a view to monitoring and improving the quality of the service.

We spoke with four people about their experiences whilst visiting the dental practice. Consistently we were told that patients found the staff team to be polite, caring, friendly, and that people were treated sensitively and with respect.

People told us that they were provided with good information both about their treatment options and the cost of different treatments. People also said that they had realistic expectations of the procedures they were having. One person who had been visiting the dental practice for a considerable number of years told us, “Excellent, it has always been an excellent dentist. Everybody puts at ease. Any questions are always answered. They work very well under pressure”.

We were also told that the dental practice was accommodating with regard to unexpected visits. Another person explained, “I came here the first time because I had tooth ache. I got an appointment the same day. They are also very good in booking us in as a family so we can all come together at the same time. Everybody is very friendly they seem to take care of you as an individual. They always ask how you are and how the treatment has been”.

Everybody we spoke with told us that they always felt safe when visiting the dental practice. Two people also confirmed that in the past they had been asked to complete a survey about their experience of visiting the dental practice. This was undertaken by another agency and outcomes helped to inform internal quality monitoring.