We carried out a follow- up, desk based inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions at Skirsgill Dental surgery on the 25 July 2017.

We had undertaken an announced comprehensive inspection of this service on the 25 May 2017 as part of our regulatory functions where a breach of legal requirements was found.

After the comprehensive inspection, the practice manager wrote to us to say what they would do to meet the legal requirements in relation to the breach. This report only covers our findings in relation to that requirement.

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 Skirsgill Dental Practice on our website at www.cqc.org.uk.

Our findings were:

Are services well-led?

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

Background

The practice is situated in an industrial park setting on the outskirts of Penrith Cumbria. The practice offers both NHS and limited private primary care dentistry to both adult patients and children.

Staff employed at the practice include the principal dentist, two dental nurses, one receptionist and the practice manager.

The practice is open:

Monday, Tuesday and Thursday between 9.00am and 5.00pm.

Wednesday the practice is open 10.00am to 6.00pm. Friday the practice opens at 9.00am to 4.00pm.

The practice is owned by an individual. 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.

Our key findings were:

• The practice had completed an infection control audit using a recognised audit tool and a radiograph audit.
• All missing emergency medical equipment had been purchased.
• Staff recruitment procedures have been review and necessary employment checks had been undertaken.
• Staff appraisals had been performed where any training needs were identified. Training was now monitored by the practice manager.
• The practice had addressed the actions identified in their Legionella risk assessment.
• Safety Data Sheets had been obtained for all COSHH products used in the practice.

We carried out this announced inspection on 25 May 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.

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

Skirsgill Dental Practice is situated on the outskirts of Penrith and provides NHS and private treatment to patients of all ages.

There is level access for people who use wheelchairs and pushchairs. Car parking spaces are available near the practice.

The dental team includes the principal dentist, two dental nurses, one receptionist and a practice manager. The practice has one treatment room.

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 17 CQC comment cards filled in by patients. This information gave us a positive view of the practice.

During the inspection we spoke with the principal dentist, two dental nurses, one receptionist 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, Tuesday and Thursday between 9.00am and 5.00pm. It closed for lunch between 12.30 and 1.30pm. Wednesday the practice is open 10.00am to 6.00pm closing for lunch between 1.30 to 2.30pm. On a Friday the practices opens at 9.00am and closes at 4.00pm. Lunch is between 12.00 to 1.00pm.

Our key findings were:

• The practice was clean and well maintained.
• Although the practice had infection control procedures these did not fully reflect published guidance.
• Staff knew how to deal with emergencies. Some emergency medicines and life-saving equipment were not available.
• The practice had 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 thorough staff recruitment procedures but these were not documented.
• 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 the availability of 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.

• Ensure the practice implements the actions identified within their Legionella risk assessment and 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 the practice's recruitment policy and procedures are suitable and the recruitment arrangements are in line with Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 to ensure necessary employment checks are in place for all staff and the required specified information in respect of persons employed by the practice is held.

• Ensure infection control audits are undertaken at regular intervals and learning points are documented and shared with all relevant staff.

• Ensure audits of various aspects of the service, such as radiography and dental care records are undertaken at regular intervals to help improve the quality of service. Practice should also ensure all audits have documented learning points and the resulting improvements can be demonstrated.

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 its responsibilities as regards the Control of Substances 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 and handling of these substances.
• Review protocols to ensure staff are up to date with their Continuing Professional Development (CPD).

We spoke with three patients when we inspected the practice who all commented they were very happy with the service. They all said they saw the dentist regularly and felt the care they received was excellent.

They confirmed that the dentist always explained what they were doing, what they had found during examination and what the treatment options were. They confirmed they had received information to enable them to decide upon treatment options.

Patients confirmed that the practice appeared very clean and staff always wore protective equipment when treating them. Feedback received from patients during the inspection confirmed that patients were happy with the service they receive.

One patient told us: “Staff are really friendly. I would advise anyone to come here.”

Another said: “I never have to wait long for an appointment. I work most days and they always manage to find me an appointment to suit.”

We were also told: “I always get a good explanation of what treatment is needed. The practice is efficient and well run.”