We carried out a focused inspection of Smile Care Twyford Limited known locally as Berkshire Dental Care on 3 January 2018.

The inspection was led by a CQC inspector who had access to telephone support from a dental clinical adviser.

We carried out the inspection to follow up concerns we originally identified during a comprehensive inspection at this practice on 21 March 2016 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions.

At a comprehensive inspection we always ask the following five questions to get to the heart of patients’ experiences of care and treatment:

• Is it safe?
• Is it effective?
• Is it caring?
• Is it responsive to people’s needs?
• Is it well-led?

When one or more of the five questions is 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 area where improvement was required.

At the previous comprehensive inspection we found the registered provider was providing safe, effective, caring and responsive care in accordance with relevant regulations. We judged the practice was not providing well-led care in accordance with 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 Smile Care Twyford Limited known locally as Berkshire Dental Care on our website www.cqc.org.uk.

Our findings were:

Are services well-led?

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

The provider had made improvements to put right the shortfalls and deal with the regulatory breach we found at our inspection on 21 March 2016.

We carried out an announced comprehensive inspection on 21 March 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 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

Smile Care Twyford (also known as Berkshire Dental Care) is located in converted premises in the centre of Twyford. There are four dental treatment rooms at the practice and all are on the ground floor. The practice is part of a group of practices. There are four dentists, a foundation dentist (a foundation dentist is a qualified dentist undertaking a year of practice under supervision), a dental hygienist, a part time dental nurse, four trainee dental nurses, a practice manager and a receptionist.

The practice is open from 9am every morning. It closes at 6pm on a Monday, 5.30pm from Tuesday to Thursday and at 5pm on a Friday.

The practice was in the process of changing their registered manager. At the time of inspection CQC had received notifications of the departure of the previous manager and the pending application of the new manager. We noted that the incoming manager had applied for, and was awaiting, their Disclosure and Barring Service (DBS) check. (A DBS check identifies whether a person has a criminal record or is on an official list of people barred from working in roles where they may have contact with children or adults who may be vulnerable). A registered manager is a person who is registered with the Care Quality Commission to manage the service. 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.

Eleven patients gave us feedback about the service. There were six completed comment cards and we spoke with five patients in person. All were positive about the service they received particularly focussing on the dentists being caring and giving them information upon which to make decisions about their care. Patients also said they were not rushed and had sufficient time for their examinations and treatments.

The inspection found the practice had breached Regulation 17, Good Governance, of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The registered person had not carried out mandatory X-ray and infection control audits and did not have appropriate arrangements in place to ensure emergency equipment was in working order. We have issued a requirement notice asking the provider to take action to address these risks.

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

Our key findings were:

• Staff had been trained to handle emergencies.
• Patients’ needs were assessed and care was planned and delivered in line with general professional and other published guidance.
• The practice was visibly clean and well maintained.
• Staff received training relevant to their roles and were supported in their continuing professional development.
• Appropriate arrangements were mostly in place to protect patients from the risks posed by exposure to X-rays. However, the practice could not demonstrate that they had undertaken an audit of the quality of X-rays taken.
• There was appropriate equipment for staff to undertake their duties, and equipment was well maintained. However the practice had not completed adequate checks of the automated external defibrillator and medical oxygen.
• The provider held emergency medicines in line with the British National Formulary (BNF) guidance for medical emergencies in dental practice.
• Governance arrangements were in place for the smooth running of the practice; however the practice did not have a structured plan in place to audit quality and safety including the mandatory audits for infection control and radiography. They planned to establish a more detailed system for this.

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

• Undertake mandatory audits including an audit of the infection control measures in place and the suitability of the environment in reducing risks of cross infection. It must also undertake audits of the outcome of X-rays. The practice should also ensure all audits have documented learning points and the resulting improvements can be demonstrated.

• Ensure staff that check the emergency equipment are appropriately trained to identify whether the equipment is in working order and fit for use.

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

• Gain access to NHS Choices website and respond to patient comments lodged there.
• Undertake fire evacuation drills.