Puredental

We undertook a follow-up focused inspection of Puredental on 16 October 2018. The inspection was carried out to review in detail the actions taken by the provider to improve the quality of care, and to confirm whether 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 Puredental on 23 May 2018 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?

• Is it well-led?

We found the registered provider was not providing safe and well-led care, and was in breach of Regulations 12 and 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 Puredental on our website www.cqc.org.uk.

When one or more of the five questions are not met we require the provider to make improvements and send us an action plan. We then inspect again after a reasonable interval, focusing on the areas where improvement was necessary.

As part of this inspection we asked:

• Is it safe?

• Is it well-led?

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 breach we identified at our inspection on 23 May 2018.

Are services well-led?

We found this practice was not providing well-led care in accordance with the relevant regulations.

The provider had made insufficient improvements to address the shortfalls and respond to the regulatory breaches we identified at our inspection on 23 May 2018.

Background

Puredental is in the centre of Southport and provides private dental care and treatment for patients of all ages.

There is level access to facilitate entrance to the practice for people who use wheelchairs and for pushchairs. Car parking is available near the practice.

The dental team includes a dentist and a dental nurse. The dental team is supported by a practice manager. The practice has one treatment room.

The practice is owned by a company and as a condition of registration must have a person registered with the Care Quality Commission as the registered manager. Registered managers 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 registered manager at Puredental is the principal dentist.

During the inspection we spoke to the dental nurse and the practice manager. We looked at practice policies and procedures and other records about how the service is managed. We also reviewed the provider’s action plan. We found this contained insufficient information to identify to CQC how the provider planned to comply with the Requirement Notices.

The practice is open:

Monday to Friday 9.00am to 6.00pm

Saturday 9.00am to 2.00pm

Our key findings were:

• The provider had reviewed their systems and processes for managing risk. Some of these systems were now operating effectively, for example, in relation to staff vaccinations; others, for example, in relation to fire safety and infection prevention and control, were not operating effectively.
• The provider had improved the practice's safeguarding procedures and staff knew their responsibilities for safeguarding adults and children.
• The provider had introduced procedures for monitoring staff training.
• Dental care records did not contain evidence that staff were providing patients’ care and treatment in line with current guidelines where teeth whitening procedures were carried out.
• The provider had a procedure in place for dealing with complaints. This contained all the necessary information. The practice dealt with complaints positively and efficiently.

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

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
• Send CQC a written report setting out how they are assessing, monitoring and improving the quality and safety of the services provided, how they are assessing, monitoring and mitigating the risks to the health, safety and welfare of service users and others, and any plans they have for improving the standard of the services provided.

Full details of the regulation the provider is not meeting are at the end of this report.

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

• Review the practice's risk management systems for monitoring and mitigating the various clinical and non-clinical risks arising from the undertaking of the regulated activities, specifically in relation to staff working alone in the practice.

We carried out this announced inspection on 23 May 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 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

Puredental is in the centre of Southport and provides private dental care and treatment for patients of all ages.

There is level access to facilitate entrance to the practice for people who use wheelchairs and for pushchairs. Car parking is available near the practice.

The dental team includes two dentists and two dental nurses. The practice has one treatment room. The dental team is supported by a practice manager.

The practice is owned by a company and as a condition of registration must have a person registered with the Care Quality Commission as the registered manager. Registered managers 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 registered manager at Puredental was the principal dentist.

We received feedback from 13 people during the inspection about the services provided. The feedback provided was positive about the practice.

During the inspection we spoke to the principal dentist, a dental nurse 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 to Friday 9.00am to 6.00pm

Saturday 9.00am to 2.00pm

Our key findings were:

• The practice was clean and spacious.
• The provider had infection control procedures in place which reflected most of the recognised guidance.
• Staff knew how to deal with medical emergencies.
• The provider had limited safeguarding procedures in place.
• The provider had staff recruitment procedures in place.
• Staff provided patients’ care and treatment but did not always take current guidelines into account.
• The dental team provided preventive care and supported patients to achieve better oral health.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• The appointment system took account of patients’ needs.
• The provider had a procedure in place for dealing with complaints. This was not readily available to patients.
• The practice had a leadership and management structure. We found that the practice’s governance systems were not all operating effectively.
• The provider had systems in place to manage risk. We found that systems relating to risk management were not operating effectively.
• The practice had limited processes in place for asking patients and staff for feedback about the services they provided.
• The provider had information governance arrangements in place.

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 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 protocols for assessing patients’ dental care and treatment needs taking into account current guidance, and for the completion of dental records taking into account guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.
• Review the practice's complaint handling procedures and ensure the complaints procedure is accessible to service users.
• Review the practice's risk management systems for monitoring and mitigating the various risks arising from the undertaking of the regulated activities, specifically in relation to staff working alone in the practice.