We carried out a focused inspection of Chingford Dental Care on 10 May 2018.

The inspection was led by a CQC inspector who had remote access to a specialist dental adviser.

We carried out the inspection to follow up concerns we originally identified during a comprehensive inspection at this practice on 7 September 2017 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 to people’s needs?
• Is it well-led?

When one or more of the five questions is 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.

At the previous comprehensive inspection we found the registered provider was providing safe, effective, caring and responsive care in accordance with relevant regulations. We judged the practice was not providing well-led care in accordance with Regulation 17 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 Chingford Dental Care on our website www.cqc.org.uk.

We also reviewed the key questions of safe and effective as we had made recommendations for the provider relating to these key questions. We noted that the majority of improvements had been made.

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 to put right the shortfalls and deal with the regulatory breach we found at our inspection on 7 September 2017.

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

• Review the practice’s arrangements for receiving and 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 protocols for making, monitoring and following up on referrals made to specialists in primary and secondary care to ensure that patients were seen in a timely manner.

We carried out this announced inspection on 7 September 2017 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.

We told the NHS England area team and Healthwatch that we were inspecting the practice. They did not provide any information.

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

Chingford Dental Care is located in Chingford in the London Borough of Waltham Forest. The practice provides predominantly NHS and some private dental treatments to patients of all ages.

There is located on the first floor of a purpose adapted retail premises. The practice has two treatment rooms.

The dental team includes the principal dentist, one dental nurse and one receptionist. A dental hygienist works at the practice one day each week.

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.

We received feedback from 26 patients via CQC comment cards and speaking with patients. This information gave us a positive view of the practice.

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

The practice is open between 7.30am and 2pm on Mondays to Fridays.

Our key findings were:

• The practice was clean and generally well maintained.
• 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 appointment system met patients’ needs.
• The practice asked staff and patients for feedback about the services they provided.
• The practice dealt with complaints positively and efficiently.
• The practice had infection control procedures. However there were limited systems for quality assurance of these procedures in line with published guidance.
• The practice had safeguarding processes and staff knew their responsibilities for safeguarding adults and children. However policies and procedures were not kept up to date and staff had not undertaken relevant training.
• Staff knew how to deal with emergencies. However some medicines and life-saving equipment as per current national guidelines were not available. The practice responded immediately to procure these pieces of equipment.
• The practice had 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 training, learning and development needs of individual staff members at appropriate intervals and ensure an effective process is established for the on-going assessment, supervision and appraisal of all staff.

• 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 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.

We found there were enough qualified, skilled and experienced staff to meet people’s needs. People we spoke with told us there were enough staff present to meet their personal needs. We spoke to three members of staff who told us there were arrangements in place to maintain sufficient numbers of staff to ensure the health, safety and welfare of people who used the service. We saw two contact details for agency dental staff which confirmed this.

People we spoke to told us they felt the dentist was professional and curteous. People also told us they had their treatments explained to them and they understood what procedures would be performed on them. One person told us they were "very please and satisfied" with the service and another person told us there were "no problems with the after care."