We carried out a follow-up inspection at Springs Dental Studio on 3 January 2018.

We had undertaken an unannounced focussed inspection of this service on 8 December 2017 as part of our regulatory functions where a breach of legal requirements was found.

After the focussed inspection, the practice 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 those requirements. We checked whether they had followed their action plan to confirm that they now met the legal requirements.

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

We revisited Springs Dental Studio as part of this review and checked whether they now met the legal requirements. We carried out this announced inspection on 3 January 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.

• Is it well-led?

This question forms the framework for the areas we look at during the inspection.

Our findings were:

Are services well-led?

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

Background

Springs Dental Studio is in Darlington and provides NHS and private treatment to adults and children.

There is level access for people who use wheelchairs and pushchairs. Car parking spaces, including for patients with disabled badges, are available near the practice.

The dental team includes two practice owners (one of whom is a dentist and the other is a dental nurse), two dentists, two dental nurses, one dental hygienist and a receptionist.

The practice has three surgeries. Two on the ground floor and one on the first floor, a decontamination room for sterilising dental instruments, a staff room/kitchen and a general office.

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 Springs Dental Studio was one of the partners.

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

The practice is open:

Monday, Tuesday, Wednesday and Friday 9am - 5:30pm

Thursday 9am – 5pm

Saturday for private patients 9am -12pm.

Our key findings were:

• Staff were familiar with the need to report and investigate significant events.
• A process had been implemented to ensure all instruments were stored according to current guidance.
• Procedures and processes relating to infection prevention and control had been improved.
• The practice had implemented checklists for medical emergency medicines and equipment.
• A new infection prevention and control audit had been carried out and this included an action plan.
• Recruitment documents were available for all staff.

We carried out this unannounced inspection on 8 December 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 and Healthwatch that we were inspecting the practice. We did not receive any information of concern from them.

To get to the heart of patients’ experiences of care and treatment, we asked the following questions:

• Is it safe?

• 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 well-led?

We found that this practice was not providing well-led care in accordance with the relevant regulations.

Background

Springs Dental Studio is in Darlington and provides NHS and private treatment to adults and children.

There is level access for people who use wheelchairs and pushchairs. Car parking spaces, including for patients with disabled badges, are available near the practice.

The dental team includes two practice owners, two dentists, four dental nurses, two dental hygienists and a receptionist.

The practice has three surgeries. Two on the ground floor and one on the first floor, a decontamination room for sterilising dental instruments, a staff room/kitchen and a general office.

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 Springs Dental Studio was one of the partners.

During the inspection we spoke with a dentist, two dental nurses, a dental hygienist, a receptionist and one of the practice owners. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday, Tuesday, Wednesday and Friday 9am -5:30pm

Thursday 9am – 5pm

Saturdays for private patients 9am -12pm.

Our key findings were:

• The practice was generally clean and well maintained.
• The practice had infection control procedures which did not reflect published guidance.
• Staff knew how to deal with emergencies. The practice did not have all of the appropriate medicines and life-saving equipment available. We found some equipment had expired and not been disposed of.
• The practice had some systems to help them manage risk.
• The practice staff were not fully aware of their responsibility with regards reporting and sharing information of concern, including safeguarding.
• The practice did not have thorough staff recruitment procedures.
• The practice was not registered to receive medical device alerts from Medicines and Healthcare Products Regulatory Authority (MHRA).
• The practice did not have effective leadership.

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

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.

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 protocols for the use of rubber dam for root canal treatment giving due regard to guidelines issued by the British Endodontic Society.

We carried out an announced comprehensive inspection on 20 October 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 providing well-led care in accordance with the relevant regulations.

Background

Springs dental studio is located in the city centre of Darlington and provides both NHS and private treatment to patients of all ages. There are three treatment rooms spread over two floors, a reception and waiting room, a dedicated decontamination room for sterilising dental instruments, a staff kitchen and a general office. Car parking is available on the side-streets near the practice. Access for wheelchair users or pushchairs is possible via the ramp outside and also using a portable ramp at the side door.

The practice is open Monday, Tuesday, Wednesday and Friday 0900-1730, Thursday 0900-1700 and Saturday for private patients 0900-1200.

The dental team is comprised of two practice owners, two dentists, a dental hygienist, three dental nurses, a trainee dental nurse and a receptionist.

One of the partners is the registered manager. A registered manager is a person who is registered with the Care Quality Commission (CQC) 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.

We reviewed 45 CQC comment cards on the day of our visit; patients were very positive about the staff and standard of care provided by the practice. Patients commented they found staff to be helpful, caring, good with children and felt they were treated in a clean and tidy environment. They also mentioned the overall atmosphere within the practice was very relaxed which put patients at ease.

Our key findings were:

• The practice was well organised, visibly clean and free from clutter.
• Staff were very friendly, caring and enthusiastic.
• An Infection prevention and control policy was in place. We saw the sterilisation procedures followed recommended guidance.
• The practice had systems for recording incidents and accidents.
• Practice meetings were used for shared learning.
• Dental professionals provided treatment in accordance with current professional guidelines.
• Patient feedback was regularly sought and reflected upon.
• Patients could access urgent care when required.
• Dental professionals were maintaining their continued professional development (CPD) in accordance with their professional registration.
• Complaints were dealt with in an efficient and positive manner.
• Staff received annual medical emergency training.

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

• Review their emergency medicines and equipment and the system for identifying and reordering of expired items.
• Review the practice’s protocols for the use of rubber dam for root canal treatment giving due regard to guidelines issued by the British Endodontic Society