Signature Smiles - Warrington

We undertook a follow-up focused inspection of Signature Smiles – Warrington on 23 October 2018. This inspection was carried out to review in detail the actions taken by the provider to improve the quality of care, and to confirm that they were 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 Signature Smiles - Warrington on 28 June 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 provider was not providing well-led care, and was in breach 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 Signature Smiles - Warrington 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. We then inspect again after a reasonable interval, focusing on the areas in which improvement was necessary.

As part of this inspection we asked:

• Is it well-led?

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 in relation to the regulatory breaches we identified at our inspection on 28 June 2018.

Background

Signature Smiles - Warrington is in the centre of Warrington and provides NHS and private dental care for adults and children.

There are steps at the entrance to the practice. Access can therefore be difficult for people who use wheelchairs and for those with pushchairs. Car parking spaces are available near the practice.

The dental team includes three dentists, one of whom is the principal dentist, two dental nurses, and one receptionist. The team is supported by a practice manager / compliance manager who is also a qualified dental nurse, and an area manager. The practice has two treatment rooms.

The practice is owned by an individual who is the principal dentist. 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 to two dentists, a dental nurse, and the area manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday to Friday 8.30am to 5.00pm.

Our key findings were:

• The provider had medical emergency medicines and equipment available which reflected recognised guidance.
• The provider had improved their systems for assessing, monitoring and reducing risks at the practice.
• The provider had improved their recruitment procedures and completed the necessary employment checks on staff, including Disclosure and Barring Service checks where appropriate.

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

• Review the practice's complaint handling procedures to ensure all the necessary information is available for patients to enable them to complain to other organisations should they wish to do so.
• Review the system for checking the expiry dates of all the medical emergency medicines in the practice taking into account the guidelines issued by the Resuscitation Council (UK) and the General Dental Council.

We carried out this announced inspection on 28 June 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 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

Signature Smiles - Warrington is in the centre of Warrington and provides NHS and private dental care and treatment for adults and children.

There are steps at the entrance to the practice. Access can therefore be difficult for people who use wheelchairs and for those with pushchairs. Car parking spaces are available near the practice.

The dental team includes three dentists, one of whom is the principal dentist, three dental nurses, of whom two are trainees, and one receptionist. The team is supported by a practice manager / compliance manager who is also a qualified dental nurse, and an area manager. The practice has two treatment rooms.

The practice is owned by an individual who is the principal dentist. 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.

We received feedback from 11 people during the inspection about the services provided. The feedback provided was largely positive.

During the inspection we spoke to two dentists, dental nurses, and the area manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday to Friday 8.30am to 5.00pm.

Our key findings were:

• The practice was clean and well maintained.
• The practice had infection control procedures in place which reflected published guidance.
• The whole team received training in responding to medical emergencies. Most of the recommended medical emergency medicines and equipment was available.
• The provider had systems in place to manage risk. Systems in relation to the checking of medical emergency equipment, and staff health checks were operating ineffectively.
• The provider had safeguarding procedures in place and staff knew their responsibilities for safeguarding adults and children.
• The provider had staff recruitment procedures in place. We found that the provider had not carried out Disclosure and Barring Service checks on staff where appropriate.
• 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 dental team provided preventive care and supported patients to achieve better oral health.
• The appointment system took account of patients’ needs.
• The provider had a procedure in place for dealing with complaints. We observed that insufficient information was included in it.
• The practice had a leadership and management structure in place.
• Staff felt involved and supported and worked well as a team.
• The practice asked 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:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
• Ensure care and treatment is provided in a safe way to patients.

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 training protocols to ensure staff are up to date with their essential training and their continuing professional development.
• Review the practice’s protocols in relation to the use of closed circuit television to ensure staff and patients are fully informed as to its purpose and their right to access footage.
• Review the practice's complaint handling procedures and ensure sufficient information is included to enable people to complain to other organisations.