We undertook a focused inspection of Skinnergate Dental Practice on 13 December 2018. 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 Skinnergate Dental Practice on 27 July 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 regulation 12 and 17 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 Skinnergate dental practice 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. 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 breach we found at our inspection on 27 July 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 breach we found at our inspection on August 2018.

Background

Skinnergate Dental Practice is in Darlington town centre and provides NHS treatment to adults and children.

There is step free access for people who use wheelchairs and those with pushchairs and a ground floor surgery. The toilet is on the first floor; patients with mobility difficulties are made aware of this before accepting treatment at the practice. Public parking and transport links are available near the practice.

The dental team includes two dentists, four dental nurses, two dental hygienists, and a practice manager. The dental practice has three treatment rooms.

The practice is owned by an individual who is the principal dentist there. They 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 to Thursday 9am-6pmFriday 9am to 4:30pm

Our key findings were:

• Overall governance systems had improved, policies and procedures had been reviewed, amended and the appropriate risk assessments put into place.
• Appropriate systems for cleaning, sterilising and storing of dental instruments were now in place.
• Infection control had improved including adherence to safe hand washing guidance.
• Systems were in place to assure the effectiveness of sterilisation equipment.
• Recruitment procedures and processes had improved.
• The medical emergency drugs and equipment reflected nationally recognised guidance and a robust checking system was now in place.
• Staff training was in place for medical emergencies, safeguarding and a comprehensive staff induction was in place for all new staff.

We carried out this announced inspection on 27 July 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

Skinnergate Dental Practice is in Darlington town centre and provides NHS treatment to adults and children.

There is step free access for people who use wheelchairs and those with pushchairs and a ground floor surgery. The toilet is on the first floor; patients with mobility difficulties are made aware of this before accepting treatment at the practice. Public parking and transport links are available near the practice.

The dental team includes two dentists, two hygienists, the practice manager (who is also a qualified nurse), four nurses (three of whom are trainees) and a receptionist. The dental practice has three treatment rooms.

The practice is owned by an individual who is the principal dentist there. They have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run.

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

During the inspection we spoke with the two dentists (one of whom was the principal dentist), 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 9am-6pm and Friday 9am to 4:30pm

Our key findings were:

• The practice appeared clean.
• The practice did not follow infection control procedures and up to date guidance in terms of sterilisation of instruments and the effectiveness of equipment.
• The practice did not have effective systems to manage medical device alerts from the Medicines and Healthcare Products Regulatory Authority (MHRA).
• Staff had training and knew how to deal with medical emergencies. We saw some life-saving equipment and the oxygen cylinders were out of date. Checking systems to ensure all items in the emergency medicines kit were ready for use were not reliable.
• The practice had limited systems to help them manage risks for example, in relation to fire latex and sharp instruments. Checks on the effectiveness of vaccinations and associated risk assessments were not in place.
• The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children. Staff safeguarding training was not always to an appropriate level.
• The provider did not complete thorough staff recruitment procedures and structured induction training was not in place.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• The practice was providing preventive care and supporting patients to ensure better oral health in line with current guidelines.
• The appointment system met patients’ needs.
• The practice leadership required review. A culture of continuous improvement could not be demonstrated.
• 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 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.

Full details of the regulations the provider was not meeting are at the end of this report.

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

• Review the practice's responsibilities to take into account the needs of patients with disabilities and to comply with the requirements of the Equality Act 2010.

During this visit we spoke with five patients who were receiving treatment at this dental practice. All of those people had positive comments to make about the service they received. People told us:

“I wouldn’t change my dentist”,

“I’m very nervous and he deals with me very well”,

“I wouldn’t be able to go anywhere else”,

“He always uses first names and is very friendly; I’d give him ten out of ten”,

“He uses the drill slowly as I’m frightened of the noise and that really helps”,

“I never feel I’m being rushed”,

“The dentist is very reassuring and quietly spoken”,

“Everything is explained clearly and nicely”,

“I’ve been coming here over ten years and it’s very friendly” and

“Everyone makes you feel calm”.