We carried out an announced comprehensive inspection of this service on 15 September 2015 as part of our regulatory function where a breach of legal requirements was found. After the comprehensive inspection, the practice wrote to us to say what they would do to meet the legal requirements in relation to the breach.

We followed up on our inspection of 15 September 2015 to check that the practice had implemented their plan and to confirm that they now met the legal requirements. We carried out a focused visit on 3 November 2016 to check whether the practice had taken action to address a breach of Regulation 17(1) and (2) (a)(b) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

This report only covers our findings in relation to those requirements. You can read the report from our previous comprehensive inspection by selecting the ‘all reports’ link for Malcolm Patrick Association on our website at www.cqc.org.uk.

Our findings were:

Are services well-led?

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

Key findings

• Overall we found that sufficient action had been taken to address the shortfalls identified at our previous inspection and the provider was now compliant with the regulation.

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

• Review the practice’s audit protocols for infection control at regular intervals to help improve the quality of service. They should also check all audits have documented learning points and the resulting improvements can be demonstrated. The provider should also review and amend their infection control policy so that it is specific to the practice and contains information in line with guidance from Health Technical Memorandum 01-05: Decontamination in primary care dental practices.

We carried out an announced comprehensive inspection on 15 September 2015 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

Malcolm Patrick Association is a dental practice situated in Hall Green, Birmingham. The provider is one of three dentists who co-own this practice and are all individually registered with the Care Quality Commission. During this visit we inspected one of these dentists (the provider). This report will make many references to the practice but we are actually only referring to Dr Notta’s roles and responsibilities within the practice from herein.

The dental practice is a detached property situated on a busy road. Plant equipment is stored in the basement. The ground floor includes a reception area, waiting room, two treatment rooms, staff changing room, staff room, store room and stock cupboard. The first floor has three treatment rooms, a spare room, panoral X-ray area, intra oral X-ray area, dark room (for developing X-rays) and an office.

The practice benefits from having five parking bays to the front of the premises and 12 bays at the back.

The practice offers care and treatment on a private basis only.

The practice has one dental nurse and shares one receptionist with two other providers located in the same premises. They work in one of the treatment rooms on the first floor. Opening hours are Monday to Thursday 8:30am to 5pm.

The provider is the 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.

19 patients provided feedback about this service. We looked at comment cards patients had completed prior to the inspection and we also spoke with patients on the day of the inspection. All information we received from these patients was very complimentary. Patients were positive about their experience and they commented that they were treated with care, respect and dignity.

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).
• Patients were very complimentary about the practice and told us they were treated with respect and kindness. Staff ensured there was sufficient time to explain fully the care and treatment they provided in a way patients understood. Patients commented they felt involved in their treatment and that it was fully explained to them.
• Patients were able to make emergency and routine appointments when needed.
• The practice had a complaints system in place.
• Staff told us they felt well supported and comfortable to raise concerns or make suggestions.
• There was no robust audit system in place to monitor the quality of services provided.
• There was no established system to assess and manage risks to patients, including health and safety and the management of medical emergencies.

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

• Ensure they establish an effective system to assess, monitor and improve the quality of services provided.
• Ensure they establish an effective system to assess, monitor and mitigate the risks to the health and safety of patients, staff and visitors.

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:

• Review availability of medicines and equipment to manage medical emergencies giving due regard to guidelines issued by the British National Formulary, the Resuscitation Council (UK), and the General Dental Council (GDC) standards for the dental team.
• Review the practice's protocols for completion of dental records giving due regard to guidance provided by the Faculty of General Dental Practice (FGDP) regarding clinical examinations and record keeping.
• Consider reviewing storage arrangements in the treatment room so the work surfaces are less cluttered and easier to clean.
• Maintain clear records of adverse incidents within an incident log book.