We carried out this announced inspection on 5 June 2017 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We planned the inspection in response to concerns raised to the CQC in order 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 providing well-led care in accordance with the relevant regulations.

Background

Olney Dental Centre is in the town of Olney, Buckinghamshire and provides private treatment to patients of all ages.

There is level access for people who use wheelchairs and pushchairs. Car parking spaces are available at the rear of the practice.

One dentist worked at the practice and was supported by a pool of eight dental nurses and five receptionists, who work across all five practices owned by the company.The practice has two treatment rooms.

The practice is owned by a company 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. At the time of the inspection the practice did not have a registered manager in post. Following the inspection we were informed that the process of appointing a registered manager had commenced.

On the day of inspection we collected 29 CQC comment cards filled in by patients. This information gave us a positive view of the practice.

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

The practice is open: Monday to Friday from 8.30 am to 5.30 pm.

Our key findings were:

• The practice was 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 systems to help them manage risk.
• The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• The practice had thorough staff recruitment procedures.
• 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 appointment system met patients’ needs.
• The practice had effective leadership. 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.

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

• Review the practices protocol for ensuring staff immunity to Hepatitis B and adequately assessing and mitigating the risk therein when immunity cannot be assured.

• Review the systems in place to meet the needs of patients with hearing difficulties or of those patients who do not speak or understand English.

We carried out this inspection to follow up on concerns we found at an inspection of this practice on 30 January 2015. At the inspection on 30 January 2015 we found that the practice was not meeting the regulations in relation to cleanliess and infection control, safety and suitability of (X-ray) equipment, requirements relating to workers, assessing and monitoring the quality of service provision and records. After that inspection, the practice wrote to us to say what they would do to meet the relevant regulations.

We undertook this focused inspection on 5 August 2015 to check that the practice had completed their action plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last inspection, by selecting the 'all reports' link for Olney Dental Centre on our website at www.cqc.org.uk.

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 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 providing well-led care in accordance with the relevant regulations

Olney Dental Centre is a general dental practice in Olney, Milton Keynes offering NHS and private dental treatment to adults and children.

The premises consists of a waiting area adjacent to the reception desk and two treatment rooms. There is also a separate decontamination room.

The staff at the practice consist of a full time dentist, two part time dentists, two dental nurses and a receptionist. There is also a practice manager who divides their time between Olney Dental Centre and two of the provider’s other locations at Walnut Dental Centre and Whalley Drive Clinic.

The practice does not currently have a registered manager. 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.

The practice told us after the inspection they are in the process of submitting an application for a registered manager.

Our key findings were:

• There were systems in place for identifying, investigating and learning from incidents relating to the safety of patients and staff members.

• There were effective systems in place to reduce the risk and spread of infection. We found the treatment rooms, decontamination room and equipment appeared very clean.

• The practice had systems in place for the safe management of dental radiography.

• Staff were supported to enable them to deliver care and treatment to an appropriate standard.

• There was an effective system in place for acknowledging, recording, investigating and responding to complaints, concerns and suggestions made by patients.

• The practice had comprehensive and effective quality assurance and risk management structures in place.

• Records relating to the management of the practice were appropriately maintained and could be located promptly when required.

On this occasion, we did not speak with any patients. During our inspection, we found that the different pricing arrangements offered at Olney Dental Centre were not clearly and adequately explained to patients.

We saw that all surgery areas of the practice appeared clean. However, the decontamination room did not meet specification. Some chemicals were stored incorrectly. Other infection control processes and procedures were lacking.

The premises was accessible to all and mostly adequately maintained. However, all electrical items were overdue a safety test.

The practice's Orthopantomogram (an OPG is a dental X-ray machine) and X-ray developer were incorrectly sited. The practice's radiation protection adviser was not appropriately qualified.

There were not enough dental staff hours available to provide NHS care and treatment to all patients. All staff received some basic training and nursing staff were appropriately supervised and appraised. Dentists at the practice were not properly clinically supervised and did not have the quality of their work checked or monitored.

The provider did not have an effective system to regularly assess and monitor the quality of service that patients receive. Any audits or checks completed were not used to inform practice.

Patients' personal records including medical records and other records relevant to the management of the service were inaccurate and not fit for purpose.

We originally inspected the practice in March 2013. During that inspection we found a number of concerns in relating to cleanliness and infection control and the safety, availability and suitability of equipment.

We asked the provider to address these concerns and to send us an action plan identifying what they would do to make improvements.

When we inspected the practice again in September 2014, to check that the provider had taken action to address the concerns, we did not have to speak with any patients.

We saw that improvements had been made to facilities and decoration of the building and staff now made regular checks of equipment.

We spoke with people who use the service and they told us they were happy with the service provided by the dentist. One person told us they felt well informed and were able to make decisions about treatment, without feeling pressured. We found some concerns in relation to infection control and safety of equipment.