Milk Dental

We undertook a follow-up inspection of Milk Dental on 10 December 2019. This 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 Milk Dental on 13 February 2019 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 safe and well-led care and was in breach of regulations 12,17 and 19 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 Milk Dental 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.

We undertook a follow-up inspection of Milk Dental on 5 April 2019 to review in detail the actions taken by the provider to improve the quality of care, and to confirm whether the practice was meeting the legal requirements. We focused on the requirements of regulations 12 and 19.

During the inspection we found the provider had not acted sufficiently to ensure compliance with these regulations. We also identified additional risks. We took urgent action to ensure people could not be exposed to a risk of harm and suspended the provider’s CQC registration for a period of three months to allow the provider to act on the risks. You can read our report of the

inspection by selecting the 'all reports' link for Milk Dental on our website www.cqc.org.uk.

We undertook a further follow-up inspection of Milk Dental on 9 July 2019 to review in detail the actions taken by the provider to improve the quality of care. We focused on the risks outlined in our suspension notice. We found the provider had acted sufficiently by the date of expiry of the suspension notice. You can read our report of the inspection by selecting the 'all reports' link for Milk Dental on our website www.cqc.org.uk.

As part of this follow-up inspection on 10 December 2019 we asked:

• Is it safe?

• Is it effective?

• Is it caring?

• Is it responsive to people’s needs?

• Is it well-led?

We also checked whether the provider was now meeting the requirements of regulation 17.

Our findings were:

Are services safe?

We found this practice was providing safe care in accordance with the relevant regulations.

Are services effective?

We found this practice was providing effective care in accordance with the relevant regulations.

Are services caring?

We found this practice was providing caring services in accordance with the relevant regulations.

Are services responsive?

We found this practice was providing responsive care in accordance with the relevant regulations.

Are services well-led?

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

We also found that the provider had made improvements in relation to the regulatory breach we identified at our inspection on 13 February 2019.

Background

Milk Dental is in a residential suburb of Liverpool and provides NHS and private dental care for adults and children.

Car parking spaces are available near the practice.

The dental team includes a principal dentist and a dental nurse. The practice has two treatment rooms.

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.

During the inspection we spoke to the principal dentist. 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 5.00pm.

Our key findings were:

• The practice was visibly clean.
• The practice had infection control procedures in place which reflected published guidance.
• The provider had safeguarding procedures in place.
• Appropriate medicines and equipment were available for responding to medical emergencies.
• The provider had staff recruitment procedures in place.
• The dentist provided preventive care and supported patients to achieve better oral health.
• The practice 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 handling complaints.
• The provider had systems in place to manage risk. No provision had been made for reviewing risks at the practice. Insufficient measures had been put in place in relation to other risks.
• The provider had systems to support the management and delivery of the service, to support governance and to guide staff.
• The practice asked patients and staff for feedback about the services they provided.

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

• Improve the practice's systems for assessing, monitoring and mitigating the various risks arising from the undertaking of the regulated activities.
• Take action to ensure that all clinical staff have adequate immunity against vaccine-preventable infectious diseases.
• Take action to ensure the guidelines issued by the British Society of Periodontology are taken into account.
• Take action to ensure the practice’s arrangements for good governance and leadership are sustained in the longer term.

We are continuing to liaise with our colleagues at NHS England in monitoring and supporting the provider.

We undertook a follow-up, focused inspection of Milk Dental on 9 July 2019. This 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 Milk Dental on 13 February 2019 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 safe and well-led care, and was in breach of regulations 12, 17 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can read our report of the inspection by selecting the 'all reports' link for Milk Dental on our website www.cqc.org.uk.

We undertook a follow-up inspection of Milk Dental on 5 April 2019 under section 60 of the Health and Social Care Act 2008 as part of our regulatory functions, to review in detail the actions taken by the provider to improve the quality of care, and to confirm whether the practice was meeting the legal requirements. We focused on the requirements of regulations 12 and 19.

During the inspection we found the provider had not acted sufficiently to ensure compliance with these regulations. We also identified additional risks. We took urgent action to ensure people could not be exposed to risk of harm and suspended the provider’s CQC registration for a period of three months to allow the provider to act on the risks. You can read our report of the inspection by selecting the 'all reports' link for Milk Dental on our website www.cqc.org.uk.

As part of the follow-up inspection on 9 July 2019 we asked:

• Is it safe?

We found the provider was not providing safe care and had not fully complied with Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Our findings were:

Are services safe?

We found this practice was not providing safe care in accordance with the relevant regulations.

The provider had made insufficient improvements to address the regulatory breaches and risks we identified at our inspections on 13 February 2019 and 5 April 2019.

Background

Milk Dental is in a residential suburb of Liverpool and provides NHS and private dental care for adults and children.

The dental team includes a principal dentist. The practice has two treatment rooms.

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 to the dentist. We looked at practice policies and procedures and other records about how the service is managed. We also reviewed the provider’s action plan and evidence sent to us to support the action plan.

The practice is open:

Monday, Wednesday and Friday 8.45am to 5.15pm

Tuesday and Thursday 8.45am to 7.00pm.

Our key findings were:

• The provider had acted on some issues but had not acted sufficiently in relation to the strength and safety of the practice floor to ensure people were not exposed to a risk of harm.

We identified a regulation the provider was continuing not to meet. They must:

• Ensure care and treatment is provided in a safe way to patients

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

We undertook a follow-up focused inspection of Milk Dental on 5 April 2019. This 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 Milk Dental on 13 February 2019 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 safe and well-led care, and was in breach of regulations 12, 17 and 19 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 Milk Dental 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. This inspection focused on regulations 12 and 19. We will inspect to check compliance with regulation 17 at a later date in accordance with our enforcement action timeframes.

As part of this inspection we asked:

• Is it safe?

Our findings were:

Are services safe?

We found this practice was not providing safe care in accordance with the relevant regulations.

The provider had made insufficient improvements to address the regulatory breaches we identified at our inspection on 13 February 2019.

Background

Milk Dental is in a residential suburb of Liverpool and provides NHS and private dental care for adults and children.

The practice is accessed via a flight of steps. Car parking is available nearby.

The dental team includes the principal dentist, and two dental nurses. The team is supported by a practice manager. The practice has two treatment rooms.

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 to the dentist, and the dental nurses. We looked at practice policies and procedures and other records about how the service is managed. We also reviewed information the provider had sent to us to support compliance.

The practice is open:

Monday, Wednesday and Friday 8.45am to 5.15pm

Tuesday and Thursday 8.45am to 7.00pm.

Our key findings were:

• The provider had acted on some issues but had not acted sufficiently to ensure people were not exposed to a risk of harm.

We identified regulations the provider was continuing not to meet. The provider must:

• Ensure care and treatment is provided in a safe way to patients
• Ensure specified information is available regarding each person employed
• Ensure, where appropriate, persons employed are registered with the relevant professional body.

We carried out this unannounced inspection on 13 February 2019 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We planned the inspection on an unannounced basis as we had concerns that the provider may not be meeting the fundamental standards of care laid down 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

Milk Dental is in a residential suburb of Liverpool and provides NHS and private dental care for adults and children.

The practice is accessed via a flight of steps. Car parking is available nearby.

The dental team includes the principal dentist and two dental nurses. The team is supported by a practice manager. The practice has two treatment rooms.

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 to the provider, the dental nurses 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, Wednesday and Friday 8.45am to 5.15pm

Tuesday and Thursday 8.45am to 7.00pm.

Our key findings were:

• The practice was clean.
• The practice had infection control procedures in place. These did not reflect published guidance.
• The provider did not have safeguarding procedures in place.
• Staff knew how to deal with medical emergencies. Medical emergency medicines were out of date and not all the recommended medical emergency equipment was available.
• The provider had staff recruitment procedures in place. The provider did not have all the required recruitment information available.
• The provider took insufficient account of current guidelines when providing patients’ care and treatment.
• 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 did not contain all the recommended information for patients.
• The provider did not sufficiently demonstrate the leadership skills to deliver quality, sustainable care. Improvements made by the provider following previous inspections were not embedded or sustained.
• The provider had systems in place to manage risk. These were not operating effectively. Several risks had not been identified; others had not been reduced sufficiently.
• Staff felt involved and supported, and worked well as a team.
• The practice did not seek feedback from patients about the services they provided.

We identified regulations the provider was not complying with. 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
• Ensure specified information is available regarding each person employed
• Ensure, where appropriate, persons employed are registered with the relevant professional body.

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 system for recording, investigating, and reviewing incidents and significant events with a view to preventing further occurrences and ensuring that improvements are made as a result.
• Review the practice’s arrangements for 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 complaint handling procedures. In particular, ensure sufficient information, including contact details for NHS England and the Dental Complaints Service, is available for patients.