We carried out a focused inspection of Queens Terrace Dental Practice on 13 November 2017.

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

We carried out this inspection focusing only on the well-led key question to check on information we had received relating to this aspect of care at this practice.

At a comprehensive inspection we always ask the following five questions to get to the heart of patients’ experiences of care and treatment:

• Is it safe?
• Is it effective?
• Is it caring?
• Is it responsive to people’s needs?
• Is it well-led?

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 area(s) where improvement was required.

At the previous comprehensive inspection we found the registered provider was providing safe, effective, caring and responsive care in accordance with relevant regulations. We judged the practice was not providing well-led care in accordance with regulation 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 Queens Terrace Dental Practice on our website www.cqc.org.uk.

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 put right the shortfalls and dealt with the regulatory breach we found at our inspection on 11 October 2016.

We carried out an announced comprehensive inspection on 11 October 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

Queen’s Terrace Dental Practice is a dental practice providing NHS and private treatment for both adults and children. The practice is based in a converted domestic dwelling in Southampton, a town situated in south Hampshire.

The practice has two dental treatment rooms, one of which one is based on the ground floor and a separate decontamination room used for cleaning, sterilising and packing dental instruments. The ground floor is not accessible to wheelchair users, prams and patients with limited mobility without support from staff due to the physical make-up of the building. Patients who require level access are referred to a nearby practice.

The practice employs a dentist (the practice owner), a decontamination nurse and a receptionist who is also a dental nurse.

The practice’s opening hours are 8.30am to 1pm and 1.30pm to 5.50pm Monday to Friday.

There are arrangements in place to ensure patients receive urgent medical assistance when the practice is closed. This is provided by an out-of-hours service.

Dr Renata Redka is registered as an individual and is legally responsible for making sure that the practice meets the requirements relating to safety and quality of care, as specified in the regulations associated with the Health and Social Care Act 2008. 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.

We obtained the views of 10 patients on the day of our inspection.

Our key findings were:

• The practice ethos was to achieve high quality patient centred care, a feature that was captured on the 71 comments cards completed by patients prior to our inspection.
• Feedback from 10 patients during our inspection gave us a completely positive picture of a friendly, professional service.
• Appropriate medicines and life-saving equipment was readily available in accordance with current guidelines.
• The practice was visibly clean and maintained.
• Infection control procedures followed published guidance although the governance systems underpinning infection control procedures required strengthening.
• The practice owner was the dedicated safeguarding lead and there were processes in place for safeguarding adults and children living in vulnerable circumstances.
• The service was aware of the needs of the local population and took those these into account in how the practice was run.
• Patients could access treatment and urgent and emergency care when required.
• We found that the practice owner did not provide effective leadership due to the difficulties of combining their roles of lead clinician and registered manager in an effective way. This resulted in weak clinical governance across the practice as a whole.
• Management files contained out of date and generic operating practice policies, procedures and protocols that were not practice specific.
• We noted that the building was not fully mitigated in terms of fire risk prevention. A fire risk assessment was since carried out.

• Training in some areas had not been carried out for some considerable time and there was no system in place for recording staff training.

• Staff we spoke with were committed to providing a quality service to their patients.

• Regular staff meetings had not taken place since 2014.

• There were some clinical and non-clinical audits in place but these related to previous years and could not be considered as current.

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

• Ensure practice records are accurately maintained and written policiesand procedures are practice specific and reviewed regularly.
• Ensure the training, learning and development needs of staff members are collated and reviewed at appropriate intervals.
• Ensure an effective process is established for the on-going assessment and supervision of all staff employed.

• Ensure that a system of regular staff meetings is established.

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:

• Provide an annual statement in relation to infection prevention control required under The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance’.
• Review its responsibilities to the needs of disabled people and the requirements of the Equality Act 2010 and ensure a Disability Discrimination Act audit is undertaken for the premises. Specifically, the availability of a hearing loop for patients who are hearing aid wearers.
• Review staff understanding of Gillick competency and ensure all staff are aware of their responsibilities.
• Review the current legionella risk assessment and implement the required actions of the assessment carried out by the competent person, specifically an internal management review on a regular basis by the practice owner.
• Review the practice’s arrangements for receiving and responding to patient safety alerts, recalls and rapid response reports issued from the Medicines and Healthcare products Regulatory Agency (MHRA) and through the Central Alerting System (CAS), as well as from other relevant bodies such as Public Health England (PHE).
• Review the practice’s protocols for recording in the patients’ dental care records the use of a rubber dam.

Patients that used the dental practice told us that they were very happy with the service they received. One person we spoke with said they were “very pleased”, and another that they were happy for their whole family to be treated there. People said they were given enough information to make choices between the treatment options offered to them. They could ask questions and staff always answered them satisfactorily.

Results of a patient survey carried out by the practice showed that people were satisfied with the cleanliness of the practice and the reception service. Their treatment requirements were fully explained, and they were confident about the outcome of their treatment.

We found that people were involved in and understood the care and treatment choices available to them. They experienced effective, safe and appropriate care and treatment. The provider ensured that staff had the right skills and experience to provide the care and treatment required. They had effective systems in place to ensure that patients were cared for in a clean and hygienic environment. There were systems in place to regularly assess and monitor the quality of service that patients received.