We carried out an announced follow up focused inspection on 3 August 2017 to ask the practice the following key question; Are services well-led?

We had undertaken an announced comprehensive inspection of this service on the 25 April 2017 as part of our regulatory functions where breaches of legal requirements were found.

After the comprehensive inspection, the practice wrote to us to say what they would do to meet the legal requirements in relation to each of the breaches.

We reviewed the practice against one of the five questions we ask about services: is the service well led? You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for SimplyOne Dental on our website at www.cqc.org.uk.

We revisited SimplyOne Dental as part of this review and checked whether they had followed their action plan and to confirm that they now met the legal requirements. We checked these areas as part of this follow-up inspection and found this had been resolved.

Our findings were:

Are services well-led?

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

Background

SimplyOne Dental is in Ashton-under-Lyne and provides NHS and private treatment to patients of all ages. They also offer implant and sedation services.

The practice is located in a converted three storey terraced property. There is access for people who use wheelchairs and pushchairs. On street parking is available near the practice. The toilet is located on the first floor and is not accessible to wheelchair users.

The dental team includes seven dentists, nine dental nurses, two of whom are trainees and one dental hygiene therapist. The clinical team is supported by a practice manager and a receptionist. The practice has four treatment rooms, one on the ground floor, two on the first floor and one on the second floor.

The practice is owned by a partnership 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 SimplyOne Dental is the senior partner.

During the inspection we spoke with the registered manager and two dental nurses. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday to Thursday 9.00 am to 1.00 pm & 2.00 pm to 5.45 pm

Friday – 9.00 am to 1.00 pm & 2.00 pm to 5.00 pm

Our key findings were:

• The practice was clean and well maintained.
• The practice had infection control procedures which reflected published guidance.
• The practice had systems to help them manage risk.
• The clinical staff provided patients’ care and treatment in line with current guidelines.
• The practice had effective leadership. Staff felt involved and supported and worked well as a team.

We carried out this announced inspection on 25 April 2017 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.

We told the NHS England area team that we were inspecting the practice. They did not provide any information of concern.

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 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 One Dental is in Ashton-under-Lyne and provides NHS and private treatment to patients of all ages. They also offer implant and sedation services.

The practice is located in a converted three storey terraced property. There is access for people who use wheelchairs and pushchairs. On street parking is available near the practice. The toilet is located on the first floor and is not accessible to wheelchair users.

The dental team includes seven dentists, nine dental nurses, two of whom are trainees and one dental hygienist therapist. The clinical team is supported by a practice manager and a receptionist. The practice has four treatment rooms, one on the ground floor, two on the frst floor and one on the second floor.

The practice is owned by a partnership 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 One Dental is the senior partner.

On the day of inspection we collected 13 CQC comment cards filled in by patients. This information gave us a positive view of the practice.

During the inspection we spoke with two dentists, three dental nurses 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 to Thursday 9.00 am to 1.00 pm & 2.00 pm to 5.45 pm

Friday – 9.00 am to 1.00 pm & 2.00 pm to 5.00 pm.

Our key findings were:

• The practice appeared clean.
• The practice had infection control procedures which reflected published guidance but these were not consistently followed.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• The practice did not have effective systems to help them manage risk.
• The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• The practice had staff recruitment procedures.
• The clinical staff provided patients’ care and treatment in line with current guidelines.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• The appointment system met patients’ needs.
• Staff felt involved and supported and worked well as a team.
• The practice asked staff and patients for feedback about the services they provided.
• The practice dealt with complaints positively and efficiently.

We identified regulations the provider was not meeting. They must:

• Ensure an effective system is established to assess, monitor and mitigate the various risks arising from undertaking of the regulated activities. In particular, the risks relating to decontamination procedures, infection prevention and control, expired medicines, assessing the risk from sharps and documenting appropriate action after inoculation injuries.

• Ensure the practice’s infection control procedures and protocols are suitable giving due regard to 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’.

• Ensure systems are put in place for the proper and safe management of medicines.

• Ensure the practice meets it’s responsibilities as regards to the Control of Substance Hazardous to Health (COSHH) Regulations 2002 and, ensure all documentation is up to date and staff understand how to minimise risks associated with the use of and handling of these substances.

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

• Review the 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 storage of dental care products and medicines requiring refrigeration to ensure they are stored in line with the manufacturer’s guidance and the fridge temperature is monitored and recorded or the expiry date for the medicine is adjusted.
• Review the protocols and procedures for use of X-ray equipment in compliance with IRMER 2000 & IRR 1999 and giving due regard to guidance notes on the Safe use of X-ray Equipment. The practice should review its responsibilities to respond to the needs of patients with disability and the requirements of the Equality Act 2010.

• Review its responsibilities to respond to the needs of patients with disability and the requirements of the Equality Act 2010.

You can see full details of the regulations not being met at the end of this report.