We undertook a follow up focused inspection of Simply Smiles Manchester Limited on 24 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 specialist dental adviser.

We undertook a comprehensive inspection of Simply Smiles Manchester Limited on 12 November 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 safe and well led care and was in breach of regulations 12 (Safe care and treatment), 17 (Good governance), 18 (Staffing) and 19 (Fit and proper persons employed) 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 Simply Smiles Manchester Limited on our website www.cqc.org.uk.

As part of this inspection we asked:

• Is it safe?

• 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 (requirement notice only). We then inspect again after a reasonable interval, focusing on the areas where improvement was required.

Our findings were:

Are services safe?

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

The provider had made improvements in relation to the regulatory breaches we found at our inspection on 12 November 2018.

Are services well-led?

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

The provider had made improvements in relation to the regulatory breaches we found at our inspection on 12 November 2018.

Background

Simply Smiles Manchester Limited is in Salford and provides NHS and private treatment to adults and children. They provide inhalation sedation to adults and children.

There are some steps to access the premises. A portable ramp is available for wheelchair users. Car parking spaces are available near the practice.

The dental team includes one dentist, two trainee dental nurses, two dental hygiene therapists and a practice manager. The practice has one treatment room.

The practice is owned by a company and as a condition of registration must have a person registered with the Care Quality Commission as the registered manager. Registered managers 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 registered manager at Simply Smiles Manchester Limited is the principal dentist.

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

The practice is open:

Monday from 10am to 1:30pm

Tuesday from 2pm to 6pm

Wednesday from 9:30am to 1pm

Thursday from 5pm to 8pm (dental hygiene therapist only)

Friday from 9:20 to 1pm (dental hygiene therapist only)

Sunday from 9am to 12pm

Our key findings were:

• Improvements had been made to the infection control procedures.
• Staff had completed medical emergency training relevant to their roles and medical emergency equipment and medicines reflected nationally recognised guidance
• Systems and processes had been improved in relation to managing the risks associated with the carrying out of the regulated activities.
• Improvements had been made to the recruitment process. Further improvements are still required.
• Improvements had been made to the overall governance arrangements of the service to help ensure compliance is sustained in the longer term.

There were areas where the provider could make improvements. They should:

• Review the practice's recruitment procedures to ensure that appropriate checks are completed on part-time staff working at the practice.

We carried out this announced inspection on 12 November 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.

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 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

Simply Smiles Manchester Limited is in Salford and provides NHS and private treatment to adults and children. They provide inhalation sedation to adults and children.

There are some steps to access the premises. A portable ramp is available for wheelchair users. Car parking spaces are available near the practice.

The dental team includes one dentist, two trainee dental nurses, two dental hygiene therapists and a practice manager. The practice has one treatment room.

The practice is owned by a company and as a condition of registration must have a person registered with the Care Quality Commission as the registered manager. Registered managers 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 registered manager at Simply Smiles Manchester Limited is the principal dentist.

On the day of inspection, we collected 16 CQC comment cards filled in by patients.

During the inspection we spoke with the dentist, a locum dental nurse and the practice manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday from 10am to 1:30pm

Tuesday from 2pm to 6pm

Wednesday from 9:30am to 1pm

Thursday from 5pm to 8pm (dental hygiene therapist only)

Friday from 9:20 to 1pm (dental hygiene therapist only)

Sunday from 9am to 12pm

Our key findings were:

• The practice appeared clean and well maintained.
• Improvements could be made to the infection control process.
• There was limited evidence that all staff had completed medical emergency training. Not all medical emergency equipment and medicines were available.
• Systems and processes to help reduce the risk to patients and staff could be improved.
• The practice some had safeguarding processes in place. Staff had not completed level two safeguarding training.
• Improvements could be made to the recruitment process.
• The clinical staff provided patients’ care and treatment in line with current guidelines. Documentary evidence of the consent process could be improved.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• The provider was providing preventive care and supporting patients to ensure better oral health.
• The appointment system met patients’ needs.
• The practice asked staff and patients for feedback about the services they provided.
• The provider had a complaints procedure available.
• The provider had suitable information governance arrangements.

We identified regulations the provider was not complying with. 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 persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out the duties.
• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.

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

There were areas where the provider could make improvements. They should:

• Review the practice's protocols for completion of dental care records taking into account the guidance provided by the Faculty of General Dental Practice.

One patient told us: "Everything gets explained to me and I am never left in the dark". Another patient said "They are brilliant, they explain what they are going to do and reassure you. Every little thing in explained and I'm asked whether there is anything I want to know. They are an excellent service and very professional".

We were told that staff were trained in dealing with medical emergencies and saw evidence of staff training certificates. The clinic had emergency equipment available including a defibrillator, oxygen and emergency drugs.

One patient told us: "They are very accommodating and treat me so well. They are always nice and they are all really good girls. To sum up, I wouldn't go anywhere else. I would be heartbroken if I had to go somewhere else".

The practice had its own decontamination room with a designated infection control nurse.

We found that staff had received appropriate training to undertake their roles and responsibilities and also maintain their continued professional development (CPD). This ensured that dental staff were meeting the requirements of the General Dental Council (GDC) to maintain their registration with the Dental Care Professional Register.

We saw that annual audits of patient records were undertaken together with xray audits and cancelled appointments audits. Health and Safety (H&S) checks were also undertaken.

Accidents and incidents were recorded with appropriate action had been taken and documented.