We undertook a follow up focused inspection of Bloomsbury Dental Practice on 7 March 2019. This inspection 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 who was supported by a specialist dental adviser.

We undertook a comprehensive inspection of Bloomsbury Dental Practice on 24 July 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 safe or well led care and was in breach of regulation 17 – Good governance 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 Bloomsbury Dental Practice on our website www.cqc.org.uk.

• Is it safe?

• 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 breach we found at our inspection on 24 July 2018.

Background

Bloomsbury Dental Practice is in Bloomsbury in the London Borough of Camden. The practice provides private treatment to patients of all ages. There is step free access to the practice and the practice has four dental surgeries, one of which is located on the ground floor. The practice is situated close to public transport bus and London underground services.

The dental team includes the principal dentist and two dentist partners, three dental nurses and two dental hygienists. The clinical team are supported by a receptionist.

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 with each of the two associate dentists, 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 to Fridays between 9am and 5.30pm.

Late evening appointments are available up to 7pm by request on Tuesdays and Thursdays.

Our key findings were:

• There were arrangements to monitor and improve quality in relation to dental radiography though a system of audits.

• There suitable systems in place to deal with medical emergencies. The recommended life-saving equipment and medicines were available and staff had completed training in medical emergencies. Improvements were needed so that staff were confident in setting up emergency equipment for use.

• The practice’s sharps procedures were in compliance with the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.

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

Review staff training & availability of equipment to manage medical emergencies taking into account guidelines issued by the Resuscitation Council (UK), and the General Dental Council (GDC) standards for the dental team. This refers to ensuring that staff are confident and competent in setting up emergency equipment for use.

Review the practice's protocols for completion of dental care records taking into account guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.

We carried out this announced inspection on 24 July 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 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

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

There is step free access to the practice and the practice has four dental surgeries, one of which is located on the ground floor. The practice is situated close to public transport bus and London underground services.

The dental team includes the principal dentist and two dentist partners, three dental nurses and two dental hygienists. The clinical team are supported by a receptionist.

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.

On the day of inspection we received feedback from 46 patients.

During the inspection we spoke with each of the three 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:

Mondays to Fridays between 9am and 5.30pm.

Late evening appointments are available up to 7pm by request on Tuesdays and Thursdays.

Our key findings were:

• The practice appeared clean and well maintained.
• The practice had infection control procedures which reflected published guidance.
• The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• 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.
• 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.
• Improvements were needed to ensure that appropriate life-saving equipment were available to deal with medical emergencies.
• The practice had clearly defined leadership. There were some systems to help them assess and manage risk. However these were not always consistent or in line with current guidance and legislation.

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.

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 protocols for completion of dental care records taking into account guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.

All the six patients we spoke with were happy with their care and treatment. They told us "they [the dentists] tell you what they do and how much it [the treatment] costs”. They told us the dentists explained their treatment in a way they understood and they felt that staff were “very friendly". A patient told us that they were "very satisfied" and that this was why they "kept coming back".

We noted that staff spent time listening to the patients and explaining to them about their dental treatment. Patients told us their privacy and dignity were respected and the dental practice was clean.