We carried out an announced responsive follow up inspection on 23 May 2017 to ask the practice the following key questions; Are services well-led?

We had undertaken an announced comprehensive inspection of this service on 5 December 2016 as part of our regulatory functions where a breach of legal requirements was found.

Our findings at this inspection were:

Are services well-led?

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

Background

Regency House Dental Practice is set in a Grade 2 listed regency town house building in central Cheltenham. There are a number of stairs to ascend outside the building with hand rails on both sides.

The practice comprises a reception area and two waiting rooms, one treatment room on the ground floor one treatment room on the first floor and one treatment room on the top floor, a toilet and office space. Parking is available nearby in public car parks. As the practice is not accessible to patients with disabilities, the provider has an arrangement with the local community dental service to see patients who cannot access the practice.

The surgery provides a full range of private dental services to patients of all ages including preventative treatments, implants and full mouth reconstructions on a private basis to adults. Fees are displayed in information leaflets available in the practice for patients and on the website.

The opening times are: Monday, Tuesday and Thursday 8.30am-5.15pm; Wednesday 8.30am-7.00pm; Friday 9.00 -1.00pm. The practice is closed at weekends. The Out of Hours number is available from the telephone answering service and on the practice website. The practice is staffed by three dentists; one dental therapist and one dental hygienist; two qualified dental nurses, one of which is the practice manager; three trainee dental nurses and a receptionist.

The practice is registered with the Care Quality Commission (CQC) as a limited company and the practice manager is the registered manager. 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.

Patients commented staff put them at ease and listened to their concerns. They also reported they felt proposed treatments were fully explained to them so they could make an informed decision which gave them confidence in the care provided. Patients we spoke with and the comment cards reviewed corroborated these comments.

Our key findings were:

• The practice was well-led by an empowered practice manager and the principal dentist.
• The practice was clean and well maintained.
• Infection control procedures were robust and the practice followed published guidance.
• Staff had been trained to handle emergencies and appropriate medicines and life-saving equipment were readily available in accordance with current guidelines.
• The practice had systems in place manage risks.
• Fire management policies had been reviewed and fire risk assessments completed together with regular checks of the systems.
• There were systems in place to check all equipment had been serviced regularly, including the air compressor, autoclave, fire extinguishers, oxygen cylinder and the X-ray equipment.
• Staff understood and received safeguarding training and knew how to recognise signs of abuse and how to report it.
• Safe recruitment of staff was in place.
• Staff felt involved, supported and worked well as a team.
• There were sufficient numbers of suitably qualified staff who maintained the necessary skills and competence to support the needs of patients.
• The practice had implemented a performance review system and established an effective process for the on-going assessment and supervision of all staff.
• Treatment was well planned and provided in line with current guidelines.
• Patients were treated with dignity and respect and confidentiality was maintained.
• The appointment system met patients’ needs.
• The practice sought feedback from staff and patients about the services they provided.
• Complaints were responded to in an efficient and responsive manner.
• The storage of records relating to people employed and the management of regulated activities was in accordance with current legislation and guidance.
• The practice protocols for medicines management had been reviewed and ensured all medicines were managed and dispensed in accordance with current legislation.

• Opportunities for training and learning were available for staff and records of training were maintained.

All products identified under the Control of Substances Hazardous to Health (COSHH) 2002 Regulations had been risk assessed and stored securely.

We carried out an announced comprehensive inspection on 5 December 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 this practice was not providing safe care in accordance with the relevant regulations.

Are services effective?

We found this practice was providing effective care in accordance with the relevant regulations.

Are services caring?

We found this practice was providing caring services in accordance with the relevant regulations.

Are services responsive?

We found this practice was providing responsive care in accordance with the relevant regulations.

Are services well-led?

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

Background

Regency House Dental Practice is set in a Grade 2 listed regency town house building in central Cheltenham. There are a number of stairs to ascend outside the building with hand rails on both sides. The practice comprises a reception area and two waiting rooms, one treatment room on the ground floor, one treatment room on the first floor and a third treatment room on the second floor, toilet and office space. Parking is available nearby in public car parks. The practice is not accessible to patients with disabilities and they have an arrangement with the local community dental service to see patients who cannot access the practice.

The surgery provides a full range of private dental services to patients of all ages including preventative treatments, implants and full mouth reconstructions on a private basis to adults. Fees are displayed in information leaflets available in the practice for patients and on the website.

The opening times are: Monday, Tuesday and Thursday 8.30am-5.15pm; Wednesday 8.30am-7.00pm; Friday 8.30 -1.00pm. The practice is closed at weekends. The Out of Hours number is available from the telephone answering service and on the practice website. The practice is staffed by three dentists; one dental therapist and one dental hygienist; two qualified dental nurses, one of which is the practice manager; three trainee dental nurses and a receptionist.

The practice is registered with the Care Quality Commission (CQC) as a limited company and the practice manager is the registered manager. 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 reviewed seven CQC comment cards that had been left for patients to complete prior to our visit. In addition we spoke with three patients on the day of our inspection. Patients commented they found the practice exemplary and staff were welcoming, friendly kind and caring. Several patients commented that staff go out of their way to help.

Patients commented staff put them at ease and listened to their concerns. They also reported they felt proposed treatments were fully explained to them so they could make an informed decision which gave them confidence in the care provided. Patients we spoke with and the comment cards reviewed corroborated these comments.

Our key findings were:

• The practice carried out oral health assessments and planned treatment in line with current best practice guidance, for example from the Faculty of General Dental Practice (FGDP). Patient dental care records were detailed and showed on-going monitoring of patients oral health.
• There were systems in place to help ensure the safety of staff and patients with regard to safeguarding children and adults from abuse, maintaining the required standards of infection prevention and control. However there were limited systems to manage the safety of staff and patients in the premises and from equipment used.
• Staff had been trained to deal with medical emergencies, however not all required emergency equipment was available recommended by the Resuscitation Council UK.
• The premises and equipment appeared clean and well maintained.
• Patients’ needs were assessed, and care and treatment were delivered, in accordance with current legislation, standards and guidance.

• Patients received information about their care, proposed treatment, costs, benefits and risks and were involved in making decisions about it.

• Opportunities for training and learning were available for staff however records of training were not kept.

• Patients were treated with kindness, dignity and respect, and their confidentiality was maintained.

• The appointment system met the needs of patients, and emergency appointments were available.

• Services were planned and delivered to meet the needs of patients and reasonable adjustments were made to enable patients to receive their care and treatment.

• Arrangements for infection prevention and control met essential requirements however systems and equipment available was not always fully utilised to ensure protection and enhance patient safety.

• Governance arrangements in place were not effective to facilitate the smooth running of the service and there was no source of evidence regular audits were being used for continuous improvements.

• There was not an effective system to assess, monitor and mitigate the risks relating to the health, safety and welfare of patients, staff and visitors.
• Improvements were required to ensure there was an effective appraisal and performance review system for staff.

There were areas where the provider MUST make improvements :

• Ensure an effective system is established to assess, monitor, mitigate risks and improve the quality of service arising from undertaking the regulated activities.

• Ensure all emergency equipment as recommended by the Resuscitation Council UK is available for use in a medical emergency.

• Ensure the practice recruitment policy and procedures are suitable and the recruitment arrangements are in line with Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 to ensure necessary employment checks are in place for all staff and the required specified information in respect of persons employed by the practice is held.
• Ensure the storage of records relating to people employed and the management of regulated activities is in accordance with current legislation and guidance.
• Ensure audit protocols reflect the need to document learning points which are then shared with all relevant staff. Ensure the resulting improvements can be demonstrated as part of the audit process.
• Ensure the practice receives and responds to patient safety alerts, recalls and rapid response reports issued from the Medicines and Healthcare products Regulatory Agency (MHRA) and from Public Health England and the Department of Health.

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

• Review the practice infection control procedures and protocols taking into account guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices and The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance’ with regard to the use of the decontamination room for all decontamination processes.
• Review the practice protocols for medicines management and ensure all medicines are managed and dispensed in accordance with the Human Medicines Regulations 2012.
• Review the practice policy and the storage of products identified under the Control of Substances Hazardous to Health (COSHH) 2002 Regulations to ensure a risk assessment is undertaken and the products are stored securely.

• Review policies relating to fire management and ensure fire risk assessments are completed and identified actions implemented.

• Review the current performance review systems and establish an effective process for the on-going assessment and supervision of all staff.