During our announced comprehensive inspection of this practice on 11January 2016, we found breaches of legal requirements in relation to the Health and Social Care Act 2008. Following this inspection, the practice wrote to us to say what they would do to meet legal requirements in relation to regulation 17- Good Governance and regulation 19- Fit and proper persons employed.

We undertook this focused inspection to check that the provider had followed their improvement plan and to confirm that they now met legal requirements. This report only covers our findings in relation to this requirement. You can read the report from our previous comprehensive inspection, by selecting the 'all reports' link for Newmarket Road Dentistry at www.cqc.org.uk

Are services Well-led?

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

Key findings

• Overall, we found that adequate action had been taken to address the shortfalls identified at our previous inspection and the provider was now compliant with the regulations.

We carried out an announced comprehensive inspection on 11 January 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

Newmarket Road Dentistry is one of nine practices owned and run by the provider in the Antwerp House Group. It provides both NHS and private dentistry to patients and is based in the centre of Cambridge. The practice does not have it’s own parking and patients use public parking in the local retail areas. It is also close to a main bus route. The practice is located on three floors of the building and has limited access for patients with a disability.

The practice employs four dentists, a dental hygienist, one qualified dental nurse and two trainee dental nurses. This team are supported by an acting practice manager and an assistant manager/receptionist. The service opens weekdays 8am-5pm with extended opening hours until 6pm on Thursdays.

The service did not have a registered manager at the time of the inspection visit although the acting manager was preparing to submit an application for this role. A registered manager is a person who is registered with the Care Quality Commission to manage the service. 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.

Ten patients provided feedback about the service. Patients told us they had a good experience of care and treatment at this practice. Staff were friendly, put them at ease and listened to their needs.

Our key findings were:

• Staff were knowledgeable about safeguarding patients but improvement was needed to ensure that the management of safeguarding procedures were robust.
• There were sufficient numbers of suitably qualified staff to meet the needs of patients.
• Staff had been trained to handle emergencies; appropriate medicines were available although they had limited access to life-saving equipment.
• Infection control procedures were in place although the practice needed to review the procedures followed for rinsing and manual cleaning.
• Patient care and treatment was planned and delivered in line with evidence based guidelines and current legislation.
• 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.
• The appointment system met the needs of patients and waiting times were kept to a minimum.
• A limited number of complaints had been received and these were well managed. However further improvement was needed to complaints records and to ensure that learning was actioned and shared with staff.
• Governance arrangements were in place. The acting practice manager had planned and completed some improvements to aid the smooth running of the practice; however further improvements were required.

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

• Ensure that the processes for monitoring the quality and safety of the service are improved so that; staff use relevant procedures to promote learning from incidents and accidents, there are clear records to track prescriptions issued to patients, fire and environmental risks are assessed and managed, there is a process for monitoring the completion of staff training and annual appraisals.
• Review the procedure for rinsing and cleaning used dental instruments with due regard to guidelines issued by the Department of Health - Health Technical Memorandum

01-05: Decontamination in primary care dental practices. Ensure that staff follow cleaning guidelines detailed in The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance.

• Ensure that records are held to evidence safe recruitment of all staff in line with Schedule 3 of the Health and Social Care Act 2008(Regulated Activities) Regulations 2014.

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

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

• Review the procedures used by staff for the management of sharp instruments with due regard to the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013 and the safe and secure storage of clinical waste. (Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.
• Assess the risk of fire at the premises and ensure that procedures are in place to manage and reduce the risks.
• Review the storage of dental care products and medicines requiring refrigeration to ensure they are stored in line with the manufacturer’s guidance and the fridge temperature is monitored and recorded.
• 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.
• The practice should complete audits of the service, such as radiography, dental care records, cleanliness and infection control, at regular intervals to help improve the quality of service.
• Implement written referral procedures to guide staff when referring patients for treatment.
• Review staff awareness of the requirements of the Mental Capacity Act (MCA) 2005 and ensure all staff are aware of their responsibilities under the Act as it relates to their role.
• Review the practice information for patients on the website and in the practice leaflet about the use of sedation services to ensure it is accurate.
• Strengthen the complaints system to improve access for patients, monitoring of the policy and ensure that learning is shared to promote improvement.
• Review lead roles within the practice to ensure that staff are adequately trained and skilled for these roles.

Improve the communication structure for staff to ensure they are fully informed and involved in improving and maintaining the quality of the service.

We spoke with two people during our inspection on 19 November 2013 and they told us that they were satisfied with their care and treatment. They told us that their treatment was explained to them and carried out efficiently. Staff were found to be polite and respectful. One person told us: “I have been a patient here for two years and it’s been really good. The treatment options are explained to me and the costs are made clear”.

Care and treatment records were up to date and reflected each time a person had attended the practice for treatment.

Safeguarding policies and procedures to protect children and vulnerable adults were in place and staff had undertaken safeguarding training.

Cleanliness and the prevention of infection were well managed. This ensured that staff were competent to keep people and themselves safe from exposure to the risk of cross infection.

The practice had an effective system in place to deal with complaints that people might raise. Information was available for people who attended the practice which informed them of how to raise a concern and also how they could comment on the service they had received.