We carried out a focused inspection of Wollaston Dental Practice on 26 March 2018.

The inspection was led by a CQC inspector who was supported by a specialist dental adviser.

We carried out the inspection to follow up concerns we originally identified during a comprehensive inspection at this practice on 4 July 2017 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions.

At a comprehensive inspection we always ask the following five questions to get to the heart of patients’ experiences of care and treatment:

• Is it safe?
• Is it effective?
• Is it caring?
• Is it responsive to people’s needs?
• Is it well-led?

When one or more of the five questions is 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 area where improvement was required.

At the previous comprehensive inspection we found the registered provider was providing safe, effective, caring and responsive care in accordance with relevant regulations. We judged the practice was not providing well-led care in accordance with regulation 17 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 Wollaston Dental Practice on our website www.cqc.org.uk.

Our findings were:

Are services well-led?

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

The provider had made improvements to put right the shortfalls and deal with the regulatory breach we found at our inspection on 4 July 2017. The provider must ensure that the newly implemented improvements are embedded and sustained in the long-term in the practice.

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

• Review its responsibilities to the needs of people with a disability, including those with hearing difficulties and the requirements of the Equality Act 2010.

• Review the processes and systems in place for seeking and learning from patient feedback with a view to monitoring and improving the quality of the service.

We carried out this unannounced inspection on 4 July 2017 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 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

Wollaston Dental Practice is in Stourbridge and provides private treatment mainly to adult patients.

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

The dental team includes the principal dentist and two dental nurses, one of whom also acts as the receptionist. The practice has one treatment room that is in use and another treatment room is currently being used as the decontamination and storage 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 dentist and both dental nurses. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open: 9am to 3pm Monday to Friday

Our key findings were:

• The clinical staff provided patients’ care and treatment in line with current guidelines.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• The appointment system met patients’ needs.
• Procedures for decontamination of dental equipment reflected published guidance
• The practice was not clean and well maintained in all areas. The decontamination/storage area was extremely cluttered. Visible dirt was noted on the floor in the waiting room, patient toilet and decontamination/storage room. Window blinds within the decontamination area were dirty and skirting boards contained thick dust. We asked for cleaning schedules for these areas but were told that none were available.
• Staff knew how to deal with emergencies. Not all of the appropriate life-saving equipment was available.
• Staff had not completed intermediate life support training which is needed as the practice conducted intravenous sedation.
• The practice had systems to help them manage risk although these required updating.
• The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• The practice’s staff recruitment procedures did not ensure that all pre-employment information was obtained in line with regulations.
• Staff told us that they felt involved and supported at the practice and worked well as a team.
• The practice had not asked staff and patients for feedback about the services they provided recently but we were told that systems to obtain patient feedback would be re-introduced.

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

• Ensure effective systems are in place in order that the regulated activities at Wollaston Dental Practice are complaint with the requirements of Regulations 4 to 20A of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. With particular reference to staff recruitment and ongoing training, infection control, audit processes, systems for monitoring and mitigating risk and maintenance of equipment.

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 availability of equipment to manage medical emergencies taking into account the guidelines issued by the Resuscitation Council (UK) and the General Dental Council (GDC) standards for the dental team.

• Review the practice’s protocols for conscious sedation, taking into account the 2015 guidelines published by The Intercollegiate Advisory Committee on Sedation in Dentistry in the document 'Standards for Conscious Sedation in the Provision of Dental Care 2015.

• Review the practice's protocols for medicines management and ensure all medicines are stored and dispensed safely and securely.

• Review its responsibilities to the needs of people with a disability, including those with hearing difficulties and the requirements of the Equality Act 2010.

• Review the processes and systems in place for seeking and learning from patient feedback with a view to monitoring and improving the quality of the service.