We carried out an announced comprehensive inspection of this service on 14 December 2015 as part of our regulatory functions where breaches of legal requirements were found. After the comprehensive inspection, the practice wrote to us to say what they would do to meet the legal requirements in relation to the breach.

We carried out a follow- up inspection on 16 May 2016 to check that they had followed their plan and to confirm that they now met the legal requirements. This report only covers our findings in relation to those requirements. We revisited the Mullally dental Practice as part of this review.

You can read the report from our last comprehensive inspection by selecting the 'all reports' link for Mullally Dental Practice on our website at www.cqc.org.uk.

We carried out an announced comprehensive inspection on 14 December 2015 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 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

Mullally Dental Practice provides NHS and private dental treatment to patients of all ages. The premises are situated on the ground floor of a residential style building which included a basement. The services provided include preventative advice and treatment and routine restorative dental care. Practice staffing consists of the principal dentist who is also the owner/provider, three dental nurses, and a practice manager who also undertakes the role of dental nurse and receptionist.

The principal dentist is the registered manager. 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.

The practice consists of one treatment room, a waiting area for patients and reception area, a basement that houses the compressor, suction unit, X-ray developer, clinical waste, stock cupboard and a staff room.

The practice opening hours are 9am to 5.30pm Monday to Thurs and Friday 9-1pm

Fourteen patients provided feedback about the service. Patients we spoke with and those who completed comment cards were very positive about the care they received and about the service. Patients told us that they were happy with the dental treatment and advice they had received. They said that they could get appointments at times that suited them, including same day appointments for urgent dental treatments. Patients told us that staff were professional, kind and caring. They told us that dentists, dental nurses and receptionist were always kind, welcoming and helpful. Patients said that the dentists explained treatments in a way that they could understand, listened to them and answered any questions they had about their care and treatment. Patients who completed comment cards said that they had recommended the dental practice to their friends and families.

Our key findings were:

• The practice investigated significant and safety events and cascaded learning to staff. These events were analysed and monitored to help improve patient safety.
• Patient’s care and treatment was planned and delivered in line with evidence based guidelines and current legislation including National Institute for Health and Care Excellence (NICE).
• The practice had oxygen and appropriate medicines to respond to a medical emergency in line with British National Formulary and Resuscitation Council (UK) guidance.
• We found the treatment room and equipment appeared clean. Dental instruments were cleaned and sterilised in line with current regulations.
• The practice had whistleblowing policies and procedure and staff were aware of these and their responsibilities to report any concerns. However, staff had not received safeguarding children and adults training and were unaware of the processes to follow to raise any concerns.
• There were sufficient numbers of suitably qualified staff to meet the needs of patients.
• Patients received clear explanations about their proposed treatment, costs, benefits and risks and were involved in making decisions about it.
• Patients were treated with dignity and respect and confidentiality was maintained.
• The appointment system met the needs of patients and waiting times were kept to a minimum.
• The practice had a procedure for handling and responding to complaints, which were displayed and available to patients. The practice manager told us that no complaints had been received about the service.
• The practice had not ensured that all the specified information relating to persons employed at the practice was obtained and appropriately recorded.
• There were no systems in place to ensure that all equipment had been serviced regularly, including the suction apparatus, compressor unit, autoclave and fire extinguishers.
• The practice had not ensured that all the specified information relating to persons employed at the practice was obtained and appropriately recorded.
• The practice had carried out limited risk assessments to ensure the health and safety of staff and patients. In some instances, where risk assessments had been carried out the practice had not implemented the actions required to minimise the risks identified.
• Urgent actions recommended from a fire risk assessment undertaken in June 2015 had not been implemented.
• Not all parts of the premises, especially the basement area that housed the compressor, suction unit, X-ray developer, clinical waste storage, stock cupboard and a staff room were safe and fit for purpose.
• Governance systems were not effective. There were a range of policies and procedures in place; however they were not reviewed regularly and staff had little understanding of the importance of policies. The practice had not carried out audits in key areas, such as infection control and dental record keeping.

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

• Ensure all parts of the premises used by the service provider were suitable for the purpose for which they are being used.

• Ensure an effective system is established to assess, monitor and mitigate the various risks arising from undertaking of the regulated activities.
• 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 audits of various aspects of the service, such as radiography, infection control and dental care records are undertaken at regular intervals to help improve the quality of service. The practice should also check all audits have documented learning points and the resulting improvements can be demonstrated.
• Ensure all equipment is maintained in guidance with the manufacturer’s instructions or governing bodies

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

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

• Review the practice’s arrangements for receiving and responding to patient safety alerts, recalls and rapid response reports issued from the Medicines and Healthcare products Regulatory Agency (MHRA) and through the Central Alerting System (CAS), as well as from other relevant bodies, such as Public Health England (PHE).
• Review staff awareness of the requirements of the Mental Capacity Act (MCA) 2005 and ensure all staff are aware of their responsibilities under the Act as it relates to their role.
• Review the practice's protocols for completion of dental care records giving due regard to guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.

The Mullally Dental Practice Ltd. was a clean and professionally managed dental practice. The new dentists had begun to make improvements since taking over the practice four months before our inspection, with more changes planned to offer a broader service. People who use the service spoke positively about the plans to improve the practice and were pleased with the new dentists, describing them as "very nice" and "professional". One member of staff told us that there was obvious anxiety among long-standing patients but that this disappeared once they had seen the new dentists, and they had seen the same patients "skipping with happiness" when leaving their appointments.

People who use the service were positive in their reviews of the service and staff, and told us that treatment options and associated costs were fully explained during their visits. One person we spoke with told us they felt "better informed" than with the previous dentist. The provider was focused on improving the patient experience with open communication, modern equipment and instruments, and contemporary practices such as electronic record keeping which would allow printouts for patients to take away with them.

There were suitable safeguarding and emergency arrangements in place in order to ensure patient safety.