We visited Withington Dental Practice in March 2014 and found that improvements were required in their staff recruitment procedures, governance arrangements and record management. Following the inspection the provider prepared an action plan. The provider set realistic timescales by which the improvements would be made and a person with lead responsibilities for the actions was identified.

During this follow up inspection in August 2014 we found that the improvements required had been made by the provider.

We spoke with two patients who told us that although their experience had not always been positive, their current dentist was "really nice" and explained the treatment well. We saw that some patients had recorded positive experiences in a book, such as: "excellent service, thank you", "all the staff are friendly" and "highly recommend". Other patients recorded negative experiences, such as: "very rude and not professional", "dentist was very rude to me" and "waited too long to be seen." People also reported a range of experiences on NHS Choices. Some comments included: "The dentist was very caring and explained everything to me" and "the dentist had no care and no respect for my wishes".

Patients received adequate information about treatment options and staff respected their choices. Staff had a good understanding of consent and capacity. Patients attending for general dentistry appointments were appropriately assessed and treated; however, the records for patients attending for specialist treatments, such as sedation, did not reflect relevant guidance. The practice was clean, but staff did not follow protocol in cleaning and sterilising equipment.

Records pertaining to patients' care, to staff training, and to the management of the service were incomplete. The provider did not have a system for recording and responding to complaints or for monitoring the quality of the service.

We spoke with two patients and one relative. People spoke positively about the dental practice. One relative told us that their family member "doesn't like the dentist, but doesn't mind the care." They noted that although this was not their usual dental practice, this was the second time the patient had seen this dentist for specialist treatment and they had "no concerns."

We observed a dentist and two dental nurses provide care and treatment to four patients. We found that the staff interacted with patients in a calm way, providing reassurance at appropriate intervals.

We spoke with five staff members. Staff spoke positively about the changes to the practice since the July 2013 inspection. They told us that they met regularly as a team and felt supported by each other. One staff member described volunteer work they did in the community to promote oral health. We saw evidence that staff were encouraged to obtain further qualifications, such as completing specialist training in sedation.

The provider had acted on concerns we raised in the July 2013 inspection. This meant that they now had adequate systems in place to respond to complaints, maintain cleanliness and prevent cross-infections. Our specialist advisor, who was an experienced dentist, observed clinical practice and found that staff demonstrated their experience and competencies. Records demonstrated that staff had attended relevant training, such as fire safety or resuscitation; we saw plans in place to update this training.

Although patient records were now accurate and secure, the provider still did not have effective systems in place to manage other records. We found that the provider did not collect and maintain all information required by the regulations, when recruiting new staff. This meant that they could not provide assurances that all staff were of good character.

Although we noted improvements since the July 2013 inspection, we found that the provider still did not have an effective system to assess and monitor the quality of the service, as not all risks to people were appropriately monitored.