We carried out an announced comprehensive inspection of this service on 21 January 2016 as part of our regulatory functions where breaches of legal requirements were found. After the comprehensive inspection, the practice wrote to us to say what they would do to meet the legal requirements in relation to the breach.

We carried out a follow- up inspection on 4 May 2016 to check that they had followed their plan and to confirm that they now met the legal requirements. This report only covers our findings in relation to those requirements. We revisited the Barking Dental Practice as part of this review.

You can read the report from our last comprehensive inspection by selecting the 'all reports' link for Barking Dental Practice on our website at www.cqc.org.uk.

We carried out an announced comprehensive inspection on 21 January 2016 to ask the practice the following key questions; Are services safe, effective, caring, responsive and well-led?

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

Barking Dental Practice provides NHS and private dental treatment to patients of all ages. The services provided include preventative advice and treatment and routine restorative dental care. The practice staffing consists of a practice manager, two dentists, two dental nurses, hygienist and receptionist.

One of the owners is the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons 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 practice consists of two treatment rooms, a waiting area for patients and reception area, a staff room, X-ray/Decontamination room and a large room that is used for storage and houses the autoclaves.

The practice opening hours are 9.30am to 6.30pm Monday to Friday.

Twenty-four patients provided feedback about the service. Patients we spoke with and those who completed comment cards were very positive about the care they received and about the service. Patients told us that they were happy with the dental treatment and advice they had received.

Our key findings were:

• Patients’ care and treatment was planned and delivered in line with current legislation and evidence based guidelines such as from the National Institute for Health and Care Excellence (NICE).
• The practice had whistleblowing policies and procedure and staff were aware of these and their responsibilities to report any concerns. However, staff had not received safeguarding children and vulnerable adults training and were unaware of the processes to follow to raise any safeguarding concerns.
• There were sufficient numbers of suitably qualified staff to meet the needs of patients.
• Patients received clear explanations about their proposed treatment, costs, benefits and risks and were involved in making decisions about it.
• Patients were treated with dignity and respect and confidentiality was maintained.
• The appointment system met the needs of patients and waiting times were kept to a minimum.
• The practice had a procedure for handling and responding to complaints, which were displayed and available to patients.
• There were systems in place to ensure that all equipment had been serviced regularly, including the suction apparatus, compressor unit, autoclave and fire extinguishers.
• The practice had systems in place to investigate significant and safety events; however staff had very little understanding of what a significant event was.
• The practice had not ensured that all the specified information relating to persons employed at the practice was obtained and appropriately recorded.
• Staff training was not up to date and was not being monitored.
• The practice had not ensured that appropriate equipment, medical oxygen and all the necessary recommended medicines in line with British National Formulary and Resuscitation Council (UK) guidance were available to respond to a medical emergency.
• Infection control protocols were not being followed in line with recommended national guidance.
• Not all parts of the premises, especially the staffs’ and the patients’ toilet were fit for purpose.
• Governance systems were not effective. There were a range of policies and procedures in place; however there was little adaptation of the policies to the practice and staff did not have enough understanding of the key policies..
• The provider did not have efffective systems to monitor and improve quality, as was evident from lack of routine audits in key areas, such as radiography. Audits that had been undertaken lacked information and actions identified were not always carried out.

We identified regulations that were not being met and the provider must:

• Ensure all parts of the premises used by the service provider were suitable for the purpose for which they were being used.
• Ensure that all of the staff had undergone relevant training, to an appropriate level, in the safeguarding of children and vulnerable adults.
• Ensure the practice’s infection control procedures and protocols are suitable giving due regard to guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices and The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance’
• Ensure the practice's recruitment policy and procedures are suitable and the recruitment arrangements are in line with Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 to ensure necessary employment checks are in place for all staff and the required specified information in respect of persons employed by the practice is held.
• Ensure audits of various aspects of the service, such as radiography, are undertaken at regular intervals to help improve the quality of service. The practice should also check all audits have documented learning points and the resulting improvements can be demonstrated.

You can see full details of the regulations not being met at the end of this report.

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

• Review the practice's protocols for completion of dental care records giving due regard to guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.
• Review staff awareness of the requirements of the Mental Capacity Act (MCA) 2005 and ensure all staff are aware of their responsibilities under the Act as it relates to their role.