We undertook a follow up inspection of Poynton House Dental Surgery on 21 February 2019. 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 second CQC inspector.

We undertook a comprehensive inspection of Poynton House Dental Surgery on 16 July 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, 17 and 19 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 Poynton House Dental Surgery on our website www.cqc.org.uk.

As part of this inspection we asked:

• Is it 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 areas where improvement was required.

Our findings were:

Are services well-led?

We found this practice was not providing well-led care in accordance with the relevant regulations.

The provider had made insufficient improvements to put right the shortfalls and had not responded to all three of the regulatory breaches we found at our inspection on 16 July 2018.

Background

Poynton House Dental Surgery is in Market Drayton 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 outside the practice in their dedicated car park.

The dental team includes four dentists, five dental nurses, two dental hygienists and one receptionist. The existing practice manager was due to go on maternity leave shortly and one of the dental nurses would be given this role in their absence. The practice has four 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.

During the inspection we spoke with one dental nurse and the practice manager (who was also a qualified dental nurse). The principal dentist was due to be present but extenuating circumstances led to their absence on the day of our visit. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open between 9am and 5pm from Monday to Thursday. It is open between 9am and 4pm on a Friday.

Our key findings were:

• A written induction programme had been introduced and implemented since our previous visit.
• The practice had made improvements in their processes relating to safety alerts, staff immunisation records, induction programmes and fire safety.
• Dental care record keeping had improved.
• Radiography audits were not undertaken at regular intervals to help improve the quality of service.
• Infection control and record keeping audits did not have documented learning points and the practice was unable to demonstrate the resulting improvements.
• There was no system in place to ensure that untoward events were appropriately documented, investigated and analysed to prevent their reoccurrence.
• The practice did not have any formal policies, processes or systems to identify, manage, follow up and where required refer patients for specialist care when presenting with bacterial infections.
• Actions from the fire and the Legionella risk assessment had not been carried out.
• Record keeping was not consistently in line with current guidance.
• Staff training, learning and development needs were not reviewed at appropriate intervals and there was no effective process for the ongoing assessment and supervision of all staff employed.
• Recruitment procedures were not consistently documented. This included obtaining and suitably documenting staff’s photographic identity and evidence of indemnity insurance.

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 specified information is available regarding each person employed.

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

We carried out this announced inspection on 16 July 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 visited the practice on 24 April 2018 to complete the inspection, but we made the decision to terminate that inspection due to exceptional circumstances. We re-inspected on 16 July 2018. The content within this inspection report is based upon the evidence we reviewed at our visit in July 2018.

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

Poynton House Dental Surgery is in Market Drayton 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 outside the practice.

The dental team includes four dentists, five dental nurses (two of whom are trainees), one dental hygienist and one receptionist. There is also a practice manager who is qualified as a dental nurse. The practice has four 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.

On the day of inspection, we collected ten CQC comment cards filled in by patients.

During the inspection we spoke with two dentists, two dental nurses, one receptionist and the practice manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open between 9am and 5pm from Monday to Thursday. It is open between 9am and 4pm on a Friday.

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 limited systems to help them manage risk.
• The practice staff had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• The practice had staff recruitment procedures but these were not always consistent.
• Not all 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 did not have a culture of continuous improvement.
• 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.

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.
• Ensure specified information is available regarding each person employed

Full details of the regulation the provider is not meeting are at the end of this report.

We inspected Poynton House Dental Surgery on a quiet day. We were only able to speak to two people who used the service. They were both very complimentary about the care and treatment they received. They told us that the dentists were, “Very good” and that, “Everything is how it should be here.”

People told us they were always treated with respect and given the appropriate information about the treatment they received. They told us the dental staff always discussed their treatment plan with them and involved them in making decisions about their treatment.

People received their treatment in a clean, hygienic environment. The practice had suitable arrangements in place to ensure people were not placed at risk of cross infection.

Staff told us they were provided with good opportunities to further develop their skills and knowledge and to meet the requirement of their professional registration. However, we found that the provider did not carry out any formal supervision or appraisal of staff.

Although people we spoke with were not aware of how to complain, they told us they were confident any concerns raised would be listened to and addressed.