We carried out an announced comprehensive inspection of this practice on 22 November 2016. A breach of legal requirement was found. After the comprehensive inspection, the practice wrote to us to say what they would do to meet legal requirements in relation to Regulations 12 of the HSCA (RA) Regulations 2014 Safe Care and Treatment and Regulation 17 of the HSCA (RA) Regulations 2014 Good Governance.

You can read our report of that inspection by selecting the 'all reports' link for Rotherham Road Dental Practice on our website www.cqc.org.uk.

We carried out a focused inspection of Rotherham Road Dental Practice on 29 June 2017.This was to follow up on actions we asked the provider to take after our announced comprehensive inspection. During the inspection on 22 November 2016 we identified that the provider must improve recruitment checks and training for staff with regard to completing disclosing and barring service checks, hepatitis B immunity checks, safeguarding training and Mental Capacity Act training. The provider must improve safety checks with regard to completing risk assessments for health and safety, legionella, sharps and fire safety. The provider must ensure equipment servicing and maintenance was completed in line with manufacturer’s guidance and that assess the need for a defibrillator. In addition we identified that the provider must ensure a system was in place to identify and record significant events and regular audits are undertaken in line with recommended guidance with regards to infection control and radiography.

We reviewed the action plan supplied by the practice following the inspection in January 2017. We undertook a focused inspection on 29 June 2017 and spoke with the principal dentist, the trainee practice manager, the qualified dental nurse and the receptionist. We looked at additional evidence of the improvements made. We looked at practice policies and procedures and other records about how the service is managed.

Our findings were:

Are services safe?

We found that this practice was providing safe 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

Rotherham Road Dental Practice is a general dental practice is the Holbrooks area of Coventry. It is also known as Holbrook Dental Surgery.

The practice provides general dental treatment to adults and children funded mostly by the NHS, or privately.

There is a level access throughout the practice for people who use wheelchairs and pushchairs with all rooms being on the ground floor. The practice has a waiting room, reception area, patient toilet, staff toilet, staff kitchen, two treatment rooms (although only one is in use) and a decontamination room.

The dental team includes a principal dentist, a trainee dental nurse, a qualified dental nurse, a receptionist and a trainee practice manager.

The principal dentist is registered with the Care Quality Commission (CQC) as an individual. 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 is open:

Monday, Tuesday, Thursday and Friday - 9am to 5.30pm

Wednesday - 9am to 8pm

Saturday - 9am to 1pm

Our key findings were:

• Improvements were seen in all areas where concerns had been highlighted in the comprehensive inspection.

• The practice had systems to help them manage risk. Health and safety, legionella, sharps and a fire risk assessment had been completed and actions carried out.

• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were all in date and available including an automated external defibrillator.

• Pre-employment checks and mandatory training were carried out in line with regulation.

• Effective systems had been developed to identify and ensure the servicing of all equipment.

• Clinical audit was used effectively to highlight areas where improvements could be made.

• Policies to aid the smooth running of the service had been developed and signed by staff since our last visit to the practice.

At our announced inspection on 22 November 2016, there were areas we identified where the provider could make improvements. During our follow up inspection on 29 June 2017 improvements were seen in the following areas:

• Appropriate documentation pertaining to substances hazardous to health was kept in the practice.

• The practice was now monitoring and recording the temperature of the refrigerator used to store temperature sensitive medicines and dental materials.

• Prescription pads security in the practice had been reviewed and systems were in place to track and monitor their use.

• The principal dentist monitored the gum health of patients, and was using the nationally recognised scoring system. The principal dentist was now clear on the nationally recognised guidance in the care and treatment of patients and was applying the principles of the guidance in their treatment of patients.

We carried out an announced comprehensive inspection on 22 November 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 not 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

Rotherham Road Dental Practice is a general dental practice is the Holbrooks area of Coventry. It is also known as Holbrook Dental Surgery.

The practice provides general dental treatment to adults and children funded mostly by the NHS, or privately.

The practice is open from 9 am until 5.30 pm on Monday, Tuesday, Thursday and Friday. From 9 am until 8 pm on Wednesday and from 9 am until 1 pm on Saturday.

The practice is staffed by a principal dentist supported by a qualified dental nurse, a trainee dental nurse and a receptionist.

The practice offers domiciliary visits for patients who are unable to attend the practice.

The principal dentist is registered with the Care Quality Commission (CQC) as an individual. 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 received comments from 24 patients about the service by way of comment cards available at the practice for two weeks prior to the inspection.

Our key findings were:

• The practice was visibly clean and clutter free.

• The practice was taking on NHS patients at the time of the inspection and patients could expect to be offered an appointment within a few days.

• The practice met the national guidance in infection control measures; however they were not auditing the process to highlight any areas of improvement.

• The practice offered evening appointments on one day a week and appointments on a Saturday morning to allow flexibility for patients who had commitments during normal working hours.

• The practice carried medicines for use in a medical emergency, however certain pieces of the emergency equipment were out of date and the practice did not have an automated external defibrillator.

• Emergency medicines and equipment was not taken on domiciliary visits.

• Pertaining to the safe use of X-rays on the premises: documentation had not been recently updated. The practice were not always recording a written justification, quality grade and report of findings of all X-rays taken. X-ray quality was not audited to highlight areas for improvement.

• The practice did not have a policy regarding safeguarding vulnerable adults, and staff had not received training in this area.

• Risk assessments regarding the health and safety of staff, visitors and patients to the practice had not been completed; therefore the risks had not been adequately assessed or mitigated.

• Certain equipment had not been serviced or validated in line with manufacturers’ guidance; for example the ultrasonic cleaner and X–ray machines.

• The practice did not have a process in place to manage significant incidents.

• A legionella risk assessment had been completed a few days prior to the inspection however the report had not been received by the practice and therefore appropriate checks and actions had not been commenced at the time of the inspection.

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

• Ensure that effective systems and processes are in place and are operated effectively to ensure compliance with the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. For example; management of significant incidents, having appropriate and relevant policy available for staff to reference, use of clinical audit to highlight areas for improvement, systems in place to recognise the servicing and validation needs of equipment and training needs of staff pertaining to safeguarding, the Mental Capacity Act and Gillick competence.

• Ensure that care and treatment is provided in a safe way against the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. For example; availability of appropriate medicines and equipment for use in a medical emergency within the practice and on domiciliary visits and management of risk.

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 the current legionella risk assessment and implement the required actions including the monitoring and recording of water temperatures, giving due regard to the 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.

• Review the availability of an interpreter service for patients who do not speak English as their first language, and review the provision of a hearing loop to assist patients that used hearing aids.

• Review its responsibilities as regards to the Control of Substance Hazardous to Health (COSHH) Regulations 2002 and, ensure all documentation is up to date and comprehensive.

• Review the practice protocols regarding records of prescription forms with reference to the NHS guidance on security of prescription forms August 2013.

• Review national guidelines in the care and treatment of patients.

During our visit on the 30 November 2012 we spoke with the practice manager, the provider who was the dentist at the practice, and two trainee dental nurses.

We spoke with five people who had attended the practice. They all spoke positively about the quality of the service they had received. One person told us, "The dentist is very caring and very patient, I know I can trust him."

People told us they were given enough information about the treatment options and risks before their treatment started. One person said, "He showed us our options, advised us and made suggestions."

During our visit we saw that the practice was clean and tidy. Processes were in place to ensure that equipment was safe to use and levels of cleanliness maintained.

People told us that they were completely satisfied with the quality of the service provided to them, and that they would be happy to recommend the practice to family and friends. One person told us, "I can't praise the dentist enough his attitude was great." Another person said, "The dentist is excellent, all our family is registered with him."