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Inspection carried out on 7 December 2020

During an inspection looking at part of the service

We undertook a follow up desk-based review of The Dental Touch on 7 December 2020. This review 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.

We undertook a comprehensive inspection of The Dental Touch on 18 September 2019 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 well led care and was in breach of regulations 17 good governance and regulation 19 fit and proper persons employed 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 The Dental Touch on our website www.cqc.org.uk.

As part of this inspection we asked:

• 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 improvement was required.

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 found at our inspection on 18 September 2019.

Background

The Dental Touch is located in Kingsdown, Bristol and provides private treatment for adults and children, and NHS treatment to children.

There is level access for people who use wheelchairs and those with pushchairs. There are short stay parking spaces, including designated disabled parking spaces available near the practice.

The dental team includes three dentists, one dental nurse, one dental hygienist, and one receptionist. The practice has three treatment rooms.

The practice is owned by a partnership 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 The Dental Touch is the senior partner.

During our review, we spoke with the registered manager and we looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

  • Monday 9am to 6pm
  • Tuesday and Thursday 8am to 4pm
  • Wednesday 8am to 5pm
  • Friday 8am to 2pm

Our key findings were:

  • There were systems in place to ensure equipment was maintained in line with manufacturer’s instructions.
  • The systems to manage fire safety had improved.
  • Improvements had been made to ensure the equipment and medicines used for medical emergencies were safe to use and in date.
  • The provider had a system in place to ensure prescriptions could be tracked and monitored.
  • The provider had implemented systems for reviewing and investigating when things went wrong.
  • The provider had procedures in place to ensure they met the Mental Capacity Act 2005 requirements when treating patients in their best interests.
  • The provider had an effective system for ensuring suitable staff were recruited.

Inspection carried out on 18 September 2019

During a routine inspection

We carried out this announced inspection on 18 September 2019 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

The Dental Touch is in Kingsdown, Bristol and provides private dental treatment to adults and children and NHS treatment to children.

There is level access for people who use wheelchairs and those with pushchairs. There are short stay parking spaces including designated disabled parking spaces allocated near the practice.

The dental team includes two dentists, two dental nurses, two dental hygienists; one of which is also a dental therapist. One of the dental nurses, also acts as the practice manager and receptionist. The practice has three treatment rooms, two of which were currently in use.

The practice is owned by a partnership 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 The Dental Touch is the principal dentist.

On the day of inspection, we collected 58 CQC comment cards filled in by patients and spoke with two other patients.

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

The practice is open:

Monday 9-6pm

Tuesday and Thursday 8-4pm

Wednesday 8-5pm

Friday 8-2pm

Our key findings were:

  • The provider had infection control procedures which reflected published guidance.
  • The provider had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
  • 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.
  • Staff provided preventive care and supported patients to ensure better oral health.
  • The appointment system took account of patients’ needs.
  • The provider asked patients for feedback about the services they provided.
  • The provider dealt with complaints positively and efficiently.
  • The provider had suitable information governance arrangements.
  • Staff knew how to deal with medical emergencies. However, there was one emergency medicine that was not appropriate and some life-saving equipment was not available, in line with recognised guidance.

  • The provider had ineffective systems to help them manage risk to patients and staff, such as fire safety and radiation.
  • The provider had ineffective staff recruitment procedures.
  • Staff worked well as a team. The provider would benefit from providing more opportunities for staff as a team to feedback to continually improve the service.
  • The practice appeared clean and well maintained. Although some equipment required servicing.

We identified regulations the provider was not complying with. They must:

  • Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.
  • Ensure specified information is available regarding each person employed.
  • 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:

  • Implement protocols and procedures in relation to the Accessible Information Standard to ensure that that the requirements are complied with.
  • Implement a system to ensure patient referrals to other dental or health care professionals are centrally monitored to ensure they are received in a timely manner and not lost.
  • Improve the practice's processes for the control and storage of substances hazardous to health identified by the Control of Substances Hazardous to Health Regulations 2002, to ensure risk assessments are undertaken.

During a check to make sure that the improvements required had been made

At our inspection in January 2013 we found the practice non compliant as they had not fully implemented the Health Technical Memorandum 01-05: Decontamination in primary care dental practices guidance from the Department of Health.

We asked the provider to submit an risk assessment and plan for working safely which reduced the risk to the patients.

From this evidence we are satisfied the service is now compliant.

Inspection carried out on 29 January 2013

During a routine inspection

We spoke with one patient and the mother of two child patients either before or after they had received treatment on the day of our visit. Both were happy overall with the treatment they had received over the time they had been attending the practice. Where appropriate they had been given treatment options and the information they needed to be able to make their choice. They felt that their decisions and opinions were respected by the staff.

We found that people were given appropriate information about their treatment. Information was collected and updated about patient's medical conditions to ensure patients remained safe when being treated. Equipment was available and staff trained to deal with medical and other foreseeable emergencies. There were effective systems in place to reduce the risk and spread of infection, except that there was not a separate hand-washing sink in the decontamination room. There was a commitment by all staff to remaining appropriately trained. Patient records were compiled and maintained adequately and stored securely.