We undertook a follow up desk-based focused review of Belsize Dental Care on 12 December 2018. This review was carried out to check 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 desk-based review was carried out by a CQC inspector who had access to support by a specialist dental adviser.

We undertook a comprehensive inspection of Belsize Dental Care on 6 November 2018 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 in accordance with the relevant regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can read our reports of that inspection by selecting the 'all reports' link for Belsize Dental Care on our website www.cqc.org.uk.

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 found at our inspection on 6 November 2018.

Background

Belsize Dental Care is in the London Borough of Camden. The practice provides private treatment to patients of all ages.

The practice is situated close to public transport bus and train services.

The dental team includes the two principal dentists who own the practice, one associate dentist, two dental hygienists and three dental nurses. The clinical team are supported by a receptionist and a treatment coordinator.

The practice is owned by an organisation 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. At the time of the review the practice did not have a registered manager in post. One of the principal dentists had submitted an application to be the registered manager.

The practice is open:

Mondays, Tuesdays and Fridays from 9am to 7pm.

Wednesdays and Thursdays from 9am to 8pm

Saturday from 9am to 2pm.

We carried out this announced inspection on 6 November 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 registered provider was meeting the legal requirements in the Health and Social Care Act 2008 and associated regulations. The inspection was led by a Care Quality Commission (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

Belsize Dental Care is in the London Borough of Camden. The practice provides private treatment to patients of all ages.

The practice is situated close to public transport bus and train services.

The dental team includes the two principal dentists who own the practice, one associate dentist, two dental hygienists and three dental nurses. The clinical team are supported by a receptionist and a treatment coordinator.

The practice is owned by an organisation 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. At the time of the inspection the practice did not have a registered manager in post. One of the principal dentists had submitted an application to be the registered manager.

On the day of inspection we received feedback from six patients.

During the inspection we spoke with the principal dentist, one dental nurse, and the receptionist. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Mondays, Tuesdays and Fridays from 9am to 7pm.

Wednesdays and Thursdays from 9am to 8pm

Saturday from 9am to 2pm.

Our key findings were:

• The practice appeared clean and well maintained.
• The practice had infection control procedures.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• The practice had systems to help them manage risk. Improvements were needed so that the dentists used a rectangular collimator in accordance with taking into account Guidance Notes for Dental Practitioners on the Safe Use of X-ray Equipment
• The practice had safeguarding processes and staff knew their responsibilities for safeguarding adults and children. Improvements were needed so that staff undertook safeguarding training appropriate to their roles within the practice.
• The practice had thorough staff recruitment procedures.
• 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.
• The practice was providing preventive care and supporting patients to ensure better oral health.
• The appointment system met patients’ needs.
• Staff felt involved and supported and worked well as a team. Improvements were needed so that staff undertook training at appropriate intervals in relation to their roles and responsibilities.
• The practice asked staff and patients for feedback about the services they provided.
• The practice dealt with complaints positively and efficiently.
• The practice had suitable information governance arrangements.

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 sufficient numbers of suitably qualified, competent, skilled and experienced persons are deployed to meet the fundamental standards of care and treatment

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 storage of dental care products and medicines requiring refrigeration to ensure they are stored in line with the manufacturer’s guidance and the fridge temperature is monitored and recorded.
• Review the practice's protocols for medicines management and ensure all medicines are stored and dispensed safely and securely.
• Review the protocols and procedures for use of X-ray equipment taking into account Guidance Notes for Dental Practitioners on the Safe Use of X-ray Equipment. This relates specifically to the use of rectangular collimation.
• Review the practice’s protocols for referral of patients and ensure all referrals are monitored suitably.
• Review the current staffing arrangements to ensure all dental care professionals are adequately supported by a trained member of the dental team when treating patients in a dental setting considering the guidance issued by the General Dental Council.

This report is a follow up to our report published in April 2013.

We inspected this provider on the 22nd March 2013, when we noted and brought to the provider’s attention some issues, that included infection control auditing and record keeping, which had a minor impact on people using the service. With regard to auditing and record keeping, we set a compliance action requiring the provider to take steps to comply with Regulation 20 (1) (b) (ii) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

Following our report, the provider sent us a plan of the actions proposed to meet the requirements of the regulation. We made a further visit on the 4th July 2013 to check on the actions the provider had taken. We found that the actions were appropriate and sufficient to comply with the regulation.

We also found that the provider had taken suitable action to address other issues we had noted previously regarding obtaining feedback from people using the service, monitoring emergency use equipment and drugs, and maintaining staff records.

We found a well designed and clean practice providing high quality preventive and general private dentistry. The staff were friendly and approachable with a personal touch.

We found that the people using the service were involved in their care plans and understood what they meant and people we spoke with confirmed this.

The risk of infection was adequately controlled because some of the guidance had been followed however the provider did not routinely audit the infection control processes in the practice.

The provider did not have records and documentation available to ensure the management of the service.

The staff were very supportive of the provider and were keen to improve the practice. They told us they liked working there and felt supported in their roles.