We undertook a focused follow-up inspection of Oak Dental Care Ltd, Southport on Tuesday 27 November 2018. This inspection was carried out to review in detail the actions taken by the registered provider to improve the quality of care and to confirm that the practice was now meeting legal requirements.

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

We undertook a comprehensive inspection of Oak Dental Care Ltd, Southport on 26 June 2018 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We found the registered provider was not providing well-led care and was in breach of regulations 12 and 17 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 Oak Dental Care Ltd, Southport on our website www.cqc.org.uk.

As part of this inspection we asked:

• Are services well-led?

When one or more of the five questions are 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.

Our findings were:

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

The provider had made improvements in relation to the regulatory breaches we found at our inspection on 26 June 2018.

Background

Oak Dental Care Ltd, Southport, is based in a residential area of Southport, Merseyside. The practice provides private treatment to adults and children.

There is ramp access to the building and level access internally for people who use wheelchairs and those with pushchairs. Car parking spaces are available at the rear of practice, with street parking available to the front of the practice.

The dental team includes one dentist, two dental nurses, one of whom acts as the receptionist, and one dental hygienist. Another dental hygienist from another practice within the group does work from the practice when required. The practice has two treatment rooms.

The practice is owned by a company, Oak Dental Care Ltd and as a condition of registration must have a person registered with the Care Quality Commission as the registered manager. Registered managers 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 registered manager at Oak Dental Care Ltd, Southport was the dentist. A second registered manager is also in place, who works at the other branches of the organisation.

Our key findings were:

• The practice was clean and tidy; detailed cleaning schedules supported by cross checking, introduced since our last inspection, had brought improvements required in the cleaning of the practice, including clinical rooms.

• Staff were following recognised guidance in the management of infection control. This included the removal of fabric chairs from treatment rooms, improved oversight and management of the decontamination process and equipment to support this, and management of dental unit water lines.

• A toilet on the ground floor, which was out of use, had been decommissioned, reducing risk of Legionella caused by a dead-leg in the water supply system.

• All items of medical emergency equipment were available, including items we had identified as being missing at our previous inspection.

• Local rules in relation to the safe operation of X-ray equipment had been reviewed. Since this inspection, the practice has also updated the template they were using that provided prompts and guidance for drawing-up of local rules.

• Evidence of recruitment checks in relation to all staff was in place. Changes had been made which meant that newly appointed team leaders had oversight of staff training records to ensure that all staff remained up to date with both required training and highly recommended training.

• Appraisals were in place for all staff.

• Local rules for X-ray equipment were in place for each surgery and the equipment used. The required declaration to the Health and Safety Executive, in relation to the safe management of radiation equipment, had been made by the provider.

The provider had also made further improvements.

• Staff had access to information on products that could be hazardous to health, for example cleaning products. An appropriate folder had been put together for management of this information.

• The governance in relation to issue of prescriptions had been improved, with cross checking systems in place that also supported medicines audit.

We carried out this announced inspection on 26 June 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

Oak Dental Care Ltd, Southport, is based in a residential area of Southport, Merseyside. The practice provides private treatment to adults and children.

There is ramp access to the building and level access internally for people who use wheelchairs and those with pushchairs. Car parking spaces are available at the rear of practice, with street parking available to the front of the practice.

The dental team includes one dentist, two dental nurses, one of whom acts as the receptionist, and one dental hygienist. Another dental hygienist from another practice within the group does work from the practice when required. The practice has two treatment rooms.

The practice is owned by a company, Oak Dental Care Ltd and as a condition of registration must have a person registered with the Care Quality Commission as the registered manager. Registered managers 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 registered manager at Oak Dental Care Ltd., Southport was the dentist. A second registered manager is also in place, who works at the other branches of the organisation.

On the day of inspection, we collected 10 CQC comment cards filled in by patients and spoke with one other patient.

During the inspection we spoke with the dentist, the dental nurse and practice receptionist. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open from 9am to 12pm, and from 2pm to 5pm Monday to Thursday, and from 9am to 12pm and 2pm to 4.30pm on Friday.

Our key findings were:

• The practice appeared clean but we did find cleaning required improvement.
• The practice staff had infection control procedures in place but these did not reflect published guidance in all areas.
• Although environmental cleaning schedules were in place, evidence collected on the day of inspection demonstrated that these were not being adhered to.
• There was a lack of oversight and governance in several areas of the practice, for example in the management of the decontamination process, infection control, environmental cleaning and dental unit water line maintenance. There was no COSHH information available on products used to clean the practice.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• The practice had systems to help them manage risk however these were not always correctly followed, for example, local rules in relation to operation of X-ray equipment in line with IRMER regulations, required review.
• The practice staff had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• The practice had staff recruitment procedures in place but these did not take account of all staff checks as required by The Health and Social Care Act 2008.
• Staff training and associated to records to evidence this required review.
• 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.
• The practice had leadership that was visible and approachable.
• There was some evidence of continuous improvement including audit and continuous professional development of staff.
• Staff felt involved and supported and worked well as a team.
• The practice staff dealt with complaints positively and efficiently.
• The practice staff had some information governance arrangements in place but this required improvement.

We identified regulations the provider was not meeting. They must:

• Ensure care and treatment is provided in a safe way to patients.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

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. They should:

• Review the security of prescription pads in the practice and ensure there are systems in place to track and monitor their use, including those in daily use in the practice.
• Register the use of dental X-ray equipment with the Health and Safety Executive in compliance with the Ionising Radiations Regulations 2017.

We spoke with people using this service on the day of our visit. They told us that they were pleased with the care and treatment, that the staff were friendly and treated them with respect

They told us the clinic was clean and easy to access and that their privacy was maintained.