We carried out this unannounced inspection on 30 April 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 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 not 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

Bhageerutty Smiles is located in Lambeth. The practice has some parking nearby. The dental team includes a dentist, a trainee dental nurse and a receptionist. The practice has two treatment rooms.

The practice is owned by a company 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.

We were unable to speak with any patients on the day of the inspection. Three of the patients due to attend on the day of the inspection cancelled appointments. A patient that did attend their appointment did not want to speak with us.

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

The practice is open:

• Monday to Friday 9.30 am to 5.00pm

Our key findings were:

• The practice was generally clean but improvements were required to the state of cleanliness of some areas of the practice.
• There were shortcomings in the practice’s infection control procedures and required improvement
• Staff knew how to deal with emergencies. All recommended medicines and life-saving equipment for manging a medical emergency was not available.
• The practice had some systems to help them manage risk.
• The practice staff knew their responsibilities for safeguarding adults and children though no evidence was provided of up to date training.
• The practice had staff recruitment procedures.
• The clinical staff provided patients’ care and treatment but improvements were required
• Staff treated patients with dignity and respect
• The practice was providing preventive care.
• The appointment system met patients’ needs.

• There were no sytems to suitably monitor and record patient consent for treatment
• The practice did not monitor all referrals to make sure they were dealt with promptly.
• The practice had some systems in place to deal with complaints, but improvements were required.
• The practice did not have suitable information governance arrangements.

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

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

• Ensure that care and treatment of patients is only provided with the consent of the relevant person

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care

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

• Review the practice’s protocols for the use of rubber dam for root canal treatment taking into account guidelines issued by the British Endodontic Society.

Review the practice's complaint handling procedures and establish an accessible system for identifying, receiving, recording, handling and responding to complaints by service users.

Review the storage of dental care records to ensure they are stored securely.

• Review the practice’s system for recording, investigating and reviewing incidents or significant events with a view to preventing further occurrences and ensuring that improvements are made as a result.
• Review practice protocols for patient assessments and ensure they are in compliance with current legislation and take into account relevant nationally recognised evidence-based guidance.
• Review the processes and systems in place for seeking and learning from staff feedback with a view to monitoring and improving the quality of the service.

We did not speak to people as we did not visit the dental practice, this was desk top review.

On the inspection visit we spoke with five people receiving treatment. People told us they had confidence in the dentist, they found the principal dentist honest and interested in promoting the interests of people using the service.

People told us that the appointment system worked well, they were seen at the time scheduled and the practice was able to accommodate people in emergencies.

One person said, “I had a problem with a dental plate yesterday, the dentist advised me to come along today and he would check out the problem".

People said staff were friendly and polite, they found their approach was calming and reassuring. People told us the dentist explained clearly their treatment plan and gave them sound advice on good dental care.

The dental practice appeared clean on the day of our visit and people spoken with described the dental practice as hygienic and safe. However we saw that a surface of the clinical area in one treatment room was worn and unsuitable for the purpose, the covering on the shelf was peeling and was unsafe for storing instruments.

There were arrangements in place for the decontamination of dental instruments. However, appropriate guidance on the effectiveness of the decontamination equipment, self-assessment and evaluation of decontamination processes had not been followed.

Staff recruitment was not sufficiently robust, appropriate documentation was not sought and in place for staff before they were employed.