We carried out a follow- up inspection on 5 December 2017 at Church End Dental Clinic

We had undertaken an announced inspection of this service on 25 January 2017 as part of our regulatory functions where breach of legal requirements were found.

After the inspection, the practice wrote to us to say what they would do to meet the legal requirements in relation to the breach.

We revisited Church End Dental Clinic as part of this review and checked whether they had followed their action plan.

We reviewed the practice against one of the five questions we ask about services: is the service well-led? This report only covers our findings in relation to those requirements.

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

Background

This inspection was planned to check whether the practice was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The follow up inspection was led by a CQC inspector who was supported remotely by a specialist dental adviser.

During our inspection visit, we checked that points described in the provider’s action plan had been implemented by looking at a range of documents such as risk assessments, staff files, policies, procedures and staff training. We also carried out a tour of the premises.

Our key findings were:

• The practice had infection control procedures which reflected published guidance.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• The practice had thorough staff recruitment procedures.
• The practice had systems to help them manage risk.
• The clinical staff provided patients’ care and treatment in line with current guidelines.
• The practice had effective leadership. Staff felt involved and supported and worked well as a team.

We carried out an announced comprehensive inspection on 25 January 2017 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 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

Church End Dental Clinic is located in the London Borough of Barnet and provides NHS and private dental treatment to both adults and children. The premises are on the ground and first floor and consist of three treatment rooms, two decontamination rooms, an X-ray room and a reception area. The practice is open Monday, Wednesday and Thursday 9:00am – 6:00pm, Tuesday 9:30 – 8:00pm, Friday 8:00am – 4:00pm and Saturday 8:30am – 12:30pm.

The staff consists of the principal dentist, three associate dentists, a dental hygienist, a trainee dental nurse and four dental nurses who are also receptionists.

The principal dentist is registered with the Care Quality Commission (CQC) as an individual ‘registered person’. 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.

We reviewed 41 CQC comment cards, the NHS Friends and Family test and the practice patient satisfaction survey. Patients were positive about the service. They were complimentary about the friendly and caring attitude of the staff.

The inspection took place over one day and was carried out by a CQC inspector and a dental specialist advisor.

Our key findings were:

• There were appropriate equipment and access to emergency drugs to enable the practice to respond to medical emergencies. Staff knew where equipment was stored.

• We found the dentists regularly assessed each patient’s gum health and took X-rays at appropriate intervals.
• Patients were involved in their care and treatment planning so they could make informed decisions.
• Equipment, such as the autoclave (steriliser), fire extinguishers, and X-ray equipment had all been checked for effectiveness and had been regularly serviced.

• Patients were treated with dignity and respect.

• Patients indicated that they found the team to be efficient, professional, caring and reassuring.
• Patients had good access to appointments, including emergency appointments, which were available on the same day.
• The practice had implemented clear procedures for managing comments, concerns or complaints.

• Leadership structures were not clear and there were limited processes in place for dissemination of information and feedback to staff.
• Risks related to undertaking of regulated activities had not been suitably identified and mitigated.
• Systems were not in place to assess, monitor and improve the quality of the service

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

• Ensure the practice’s sharps handling procedures and protocols are in compliance with the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.

• Ensure the practice's recruitment policy and procedures are suitable and the recruitment arrangements are in line with Regulation 19 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 the practice establishes an effective system to assess, monitor and mitigate the various risks arising from undertaking of the regulated activities.

• Ensure systems are in place to assess, monitor and improve the quality of the service such as undertaking regular audits of various aspects of the service and ensuring that where appropriate audits have documented learning points and the resulting improvements can be demonstrated.

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

• Review its responsibilities as regards to the Control of Substance Hazardous to Health (COSHH) Regulations 2002 and, ensure all documentation is up to date and staff understands how to minimise risks associated with the use of and handling of these substances.
• 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.
• Review the practice’s arrangements for receiving and responding to patient safety alerts, recalls and rapid response reports issued from the Medicines and Healthcare products Regulatory Agency (MHRA) and through the Central Alerting System (CAS), as well as from other relevant bodies such as, Public Health England (PHE).
• Review the practice’s safeguarding policy ensuring it covers both children and adults and all staff are trained to an appropriate level for their role and are aware of their responsibilities.
• Review the practice’s infection control procedures and protocols 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.
• Review the practice’s sharps procedures giving due regard to the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013
• Review the storage of records related to people employed and the management of regulated activities giving due regard to current legislation and guidance.

We looked at the results of the provider's latest patient survey and saw that the 26 patients who responded, either “strongly agreed” or “agreed” with the statement: "I was treated with dignity and respect at all times.”

The dentist was aware of National Institute for Clinical Excellence (NICE) guidelines on patient recall intervals (the time between patient appointments). We were told that they were typically every 6-12 months but determined by individual patient circumstance including level of dental health and dietary habits.

Staff we spoke with demonstrated an understanding of safeguarding children and vulnerable adults. The dentist could describe types of abuse such as physical, emotional or verbal abuse. They also knew how, and to whom, they would report a safeguarding alert.

A dental nurse we spoke with could explain the process to be followed to ensure that dental instruments were properly cleaned. Staff were also aware of recent changes to Department of Health guidance on storage times of cleaned dental instruments.

The provider told us that patient consent forms were obtained for new courses of treatment. We were also told that patient medical history questionnaires were updated at each visit, as necessary. This meant that the provider stored records required to protect the safety and wellbeing of patients.