We undertook a focused inspection of Westmount Dental Surgery on 05 February 2019.

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 remotely by a specialist dental adviser.

We undertook a comprehensive inspection of Westmount Dental Surgery on 02 October 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 and well-led care and was in breach of regulations 12, 17 and 19 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 Westmount Dental Surgery on our website www.cqc.org.uk.

As part of this inspection we asked:

• Is it safe?

• Is it well-led?

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 improvements were required.

Our findings were:

Are services safe?

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

The provider had made improvements in relation to the regulatory breaches we found at our inspection 2 October 2018.

Are services well-led?

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

The provider had made improvements in relation to the regulatory breach we found at our inspection on 2 October 2018.

Background

Westmount Dental Surgery is in Sunderland and provides NHS and private treatment to adults and children.

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

The dental team includes five dentists (including the principal dentist), six dental nurses (two of whom are trainees), five dental hygiene therapists, a practice manager, a compliance manager, a treatment co-ordinator and two receptionists.

The practice has six treatment rooms.

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 practice manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday, Wednesday and Thursday 9am to 5pm

Tuesday 9am to 8pm

Friday 9am to 4pm

Saturday by prior appointment only.

Our key findings were:

• The practice had reviewed their governance and management systems and now had effective leadership.
• The provider had infection control procedures which reflected published guidance.
• The provider had improved their staff recruitment procedures.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• The practice had systems to help them manage risk.
• The practice’s safeguarding protocols and processes were now adequate.
• The provider reviewed their systems to ensure the security of patient dental record cards.

There were areas where the provider could make improvements. They should:

• Review the practice's protocols and procedures for the use of X-ray equipment in compliance with The Ionising Radiations Regulations 2017 and Ionising Radiation (Medical Exposure) Regulations 2017 and taking into account the guidance for Dental Practitioners on the Safe Use of X-ray Equipment.

We carried out this announced inspection on 02 October 2018, due to concerns we received, 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 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

Westmount Dental Surgery is in Sunderland and provides NHS and private treatment to adults and children.

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

The dental team includes seven dentists (including the principal dentist), eight dental nurses (three of whom are trainees), three dental hygiene therapists, a practice manager, a compliance manager, a treatment co-ordinator and three receptionists.

The practice has five treatment rooms and a sixth treatment room is currently being built.

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 29 CQC comment cards filled in by patients.

During the inspection we spoke with four dentists, five dental nurses, a dental hygiene therapist, the practice manager, the compliance manager, the treatment co-ordinator and a receptionist. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday, Wednesday and Thursday 9am to 5pm

Tuesday 9am to 8pm

Friday 9am to 4pm

Saturday by prior appointment only.

Our key findings were:

• The practice appeared clean and well maintained.
• The provider had infection control procedures which reflected published guidance with the exception of a few minor points.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available apart from a portable suction.
• The practice had some systems to help them manage risks. These required improvement.
• The practice’s safeguarding protocols and processes were inadequate.
• The provider did not have suitable staff recruitment procedures.
• Staff treated patients with dignity and respect.
• The appointment system met patients’ needs.
• The practice had leadership which required strengthening.
• A culture of continuous improvement was visible.
• 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.
• The practice did not ensure the security of patient dental record cards.

We identified regulations the provider was not complying with. 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.
• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.

There were areas where the provider could make improvements. They should:

• Review the practice's waste handling protocols to ensure gypsum waste is segregated and disposed of in compliance with the relevant regulations, and taking into account the guidance issued in the Health Technical Memorandum 07-01.

We carried out an announced comprehensive inspection on 10 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 providing well-led care in accordance with the relevant regulations.

Background

The practice is owned by Dr. Mohammed Ashfaq Quraishi.

The practice offers primary care dentistry under the NHS and private treatments. There are three surgeries located on the ground floor which are accessible to people with mobility issues.

The practice is open Monday 9am to 5pm, Tuesday 9am to 8pm, Wednesday and Thursday 9am to 6pm and Friday 9am to 4pm.

There are two dentists, two dental nurses, a dental hygiene therapist, a receptionist and a practice manager.

The owner is the registered provider for the practice. 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 received feedback from a patient about the service via six Care Quality Commission comment card and we spoke with a patient. The feedback was positive about the service they had received.

Our key findings were:

• There was an effective complaints system.
• Staff had received safeguarding training, knew how to recognise signs of abuse and how to report it.
• There were sufficient numbers of suitably qualified staff to meet the needs of patients.
• Staff had been trained to manage medical emergencies.
• Infection control procedures were in accordance with the published guidelines.
• Patient care and treatment was planned and delivered in line with evidence based guidelines and current regulations.
• 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.
• Patients could access routine treatment and urgent care when required.
• The practice was well-led, staff felt involved and supported and worked well as a team.
• The governance systems were effective.
• The practice sought feedback from staff and patients about the services they provided.

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

• Review the practice's recruitment policy and procedures to ensure that they 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.
• Review the practice’s policy and procedures for the installation and use of rectangular collimator for X-ray machines.

We looked at how the people who were using the service were supported to express their views and be involved in making decisions about their care and treatment. This included detailed treatment plans and patient records which included the options discussed and the reasons for the selection of the treatment delivered. A patient we spoke with told us "I am always happy with the care I get", and "The dentist makes sure I understand what the choices are before he does anything".

Peoples’ needs were assessed and the treatment was planned and delivered in line with their individual needs. We spoke to patients who confirmed they were always told about their options and said that the dentists they consulted took time to explain things. One told us they had chosen the dentist because his wife had recommended them. They told us that they were very pleased with the care and they were always told what was going to happen and what the choices of treatment were.

People were protected from the risk of infection because appropriate guidance had been followed for example an organised and managed decontamination room. Staff understood to follow best practice guidance for reducing the risk of cross infection and were observed using good practice during our visit.

People were cared for, or supported by, suitably qualified, skilled and experienced staff who had been subject to a selection process and had been checked to make sure they suitable to deliver the service safely.