We carried out a focused inspection of Mrs Karen Horne – Windlestone Road dental practice on 02 July 2018.

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

We undertook a comprehensive inspection of Mrs Karen Horne – Windlestone Road dental practice on 01 May 2018 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions where we found the registered provider 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 Mrs Karen Horne – Windlestone Road on our website www.cqc.org.uk.

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 areas where improvement was required.

We undertook a follow up focused inspection of Mrs Karen Horne – Windlestone Road dental practice on 02 July 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.

As part of this inspection we asked:

• Is it well-led?

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 address the shortfalls identified and responded to the regulatory breach we found at our inspection on 01 May 2018.

Background

Mrs Karen Horne - Windlestone Road practice is in Billingham and provides NHS and private treatment to patients of all ages.

The practice is situated on the first floor of a building, with entrance through the ground floor. Car parking spaces, including for blue badge holders, are available near the practice.

The dental team includes a principal dentist, two dental nurses, a dental therapist and a receptionist. The practice has two treatment rooms.

The practice is owned by an individual who is the principal dentist. 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.

The practice was not open for dental treatment on the inspection day.

During the inspection we spoke with the principal dentist and a dental nurse. Most other staff members had prior arranged annual leave. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday, Tuesday and Wednesday 9am to 5.30pm

Thursday 9am to 6pm

Friday 8.30am to 5pm

Our key findings were:

• The practice had implemented and improved their systems to help them manage risk.
• The practice had effective leadership and a culture of continuous improvement was evident.
• The principal dentist had effective staff recruitment procedures.
• We noted some staff training documents were not available during the inspection on 01 May 2018. These were not available to view at our follow-up inspection.

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

• Review the practice’s training system and ensure detailed records are maintained for all staff.

We carried out this announced inspection, in response to concerns we received, on 01 May 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.

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

Mrs Karen Horne - Windlestone Road practice is in Billingham and provides NHS and private treatment to patients of all ages.

The practice is situated on the first floor of a building, with entrance through the ground floor. Car parking spaces, including for blue badge holders, are available near the practice.

The dental team includes a principal dentist, three dental nurses (one of whom is a trainee), a dental therapist and a receptionist. 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.

Two weeks prior to the inspection, we sent comment cards to the practice for patients to complete. On the day of inspection, we found no comment cards had been filled in by patients. The practice was not open for dental treatment on the inspection day.

During the inspection we spoke with the principal dentist and the receptionist. Most other staff members had prior arranged annual leave. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday, Tuesday and Wednesday 9am to 5.30pm

Thursday 9am to 6pm

Friday 8.30am to 5pm

Our key findings were:

• The practice appeared clean and well maintained.
• The practice had 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 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.
• The practice was providing preventive care and supporting patients to ensure better oral health.
• The appointment system met patients’ needs.
• Staff felt involved and supported and worked well as a team.
• The practice asked staff and patients for feedback about the services they provided.
• The practice dealt with complaints positively and efficiently.
• The practice had suitable information governance arrangements.
• The practice had some systems to help them manage risk.
• The principal dentist did not have thorough staff recruitment procedures.
• The practice did not have effective leadership and a culture of continuous improvement was not evident.

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.

Full details of the regulations the provider was not meeting are at the end of this report.

We found that people's dignity and independence was respected. People’s views and experiences were taken into account in the way the service was provided and delivered in relation to their care. One person we spoke with told us, "It's nice here, to say that it is a pleasure coming to the dentist, well I don't think many people could say that".

People experienced care, treatment and support that met their needs and protected their rights and this care and support was provided by suitably qualified, skilled and experienced staff, in a clean and hygienic environment. One person told us, "I have never had any concerns over cleanliness in any aspect of the surgery".

There was an effective complaints system available and we found that complaints people made were responded to appropriately, one person told us, "I have never had any reason to complain but if I did I would speak to Karen directly she really is great".