We undertook a follow up focused inspection The Dental Practice on 9 November 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 The Dental Practice on 2 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, effective and well-led care in accordance with the relevant regulations 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 The Dental Practice on our website www.cqc.org.uk.

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.

As part of this inspection we asked:

• Is it safe
• Is it effective
• Is it well led

Our findings were:

Are services safe?

We found this practice was providing safe care in accordance with the relevant regulations.

Are services effective?

We found this practice was providing effective care in accordance with the relevant regulations.

Are services well-led?

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

Background

The Dental Surgery is in Barrow in Furness and provides both NHS funded treatment and private treatment to adults and children.

There is assisted access for people who use wheelchairs and those with pushchairs. On street car parking spaces are available near the practice.

The dental team includes one dentist and two dental nurses. 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.

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

The practice is open:

Monday 9.15am – 6.00pm

Thursday 9.15am – 5.30pm

Friday 9.15am – 4.30pm

Our key findings were:

• The practice had improved safeguarding processes.
• Staff files had been reviewed and now contained evidence of photographic identification, and immunity.
• A system was in place to audit radiography and infection prevention and control.
• Health and safety had improved with fire, electrical and gas systems checks in place.
• Medical emergency equipment was in place, regularly audited and accessible. Staff had completed emergency training.
• Clinical and non-clinical audits were in now place.
• The practice had improved systems to identify and manage risk effectively.
• Decontamination processes and management of treatment areas had improved.
• Patients records had improved and were consistent
• Patients surveys were in place, reviewed and shared at staff meetings.

We carried out this announced inspection on 2 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 not 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

The Dental Surgery is in Barrow in Furness and provides both NHS funded treatment and private treatment to adults and children.

There is assisted access for people who use wheelchairs and those with pushchairs. On street car parking spaces are available near the practice.

The dental team includes one dentist and two trainee dental nurses. 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 35 CQC comment cards filled in by patients.

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

The practice is open:

Monday 9.15am – 6.00pm

Thursday 9.15am – 5.30pm

Friday 9.15am – 4.30pm

Our key findings were:

• The décor in the practice needed some updating. We could not be assured that the practice was well maintained.
• The practice had infection control procedures which did not fully reflect published guidance.
• The principal dentist knew how to respond to medical emergencies. Appropriate medicines and life-saving equipment were not available.
• The practice did not have appropriate systems in place to help them manage risk.
• The practice did not have suitable safeguarding processes and staff were unsure of their responsibilities for safeguarding adults and children.
• Patient care and treatment was inconsistent and not in line with current guidelines.
• 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 but this was not recorded in the patient’s dental care records.
• The appointment system met patients’ needs.
• There was no effective leadership and culture of continuous improvement in the practice.
• The practice has limited systems in place for staff and patients to feedback about the services they provided.
• The practice had a complaints process.

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 processes and systems for seeking and learning from patient feedback with a view to monitoring and improving the quality of the service.
• Review the practice's waste handling protocols to ensure waste is segregated and disposed of in compliance with the relevant regulations, and considering the guidance issued in the Health Technical Memorandum 07-01.
• Review the practice's policy for the control of substances hazardous to health and the storage of products identified by the relevant legislation to ensure a risk assessment is undertaken and up to date data sheets are obtained.
• Review the practice’s arrangements for receiving and responding to patient safety alerts, recalls and rapid response reports issued by the Medicines and Healthcare Products Regulatory Agency, the Central Alerting System and other relevant bodies, such as Public Health England.
• Review the practice’s information leaflet to ensure information is recorded and correct to assist a patient who wished to make a complaint.