We carried out an announced comprehensive inspection of this service on 14 August 2015 as part of our regulatory functions where breaches of legal requirements were found. After the comprehensive inspection, the practice wrote to us to say what they would do to meet the legal requirements in relation to the breach.

We carried out a follow- up inspection on 13 May 2016 to check that they had followed their plan and to confirm that they now met the legal requirements. This report only covers our findings in relation to those requirements. We revisited the Dentalwork as part of this review.

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

We carried out an announced comprehensive inspection on 14 August 2015 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 not 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

Dentalwork is a private practice located in the London Borough of Lewisham. The premises consist of one surgery, a decontamination room, a waiting and reception area.

The staff structure consists of two dentists, two dental nurses and a practice manager. The practice offers appointments to patients Monday to Sunday from 9.00am to 7.00pm.

This is a new practice which registered with the Care Quality Commission (CQC) in November 2014. It has not previously been inspected. The owner who was also the practice manager was the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. 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 received three completed comment cards from patients. The feedback we received was positive about the service. Patients told us the care and treatment they received was good and they generally had positive experiences.

Our key findings were:

• The practice had processes in place to reduce and minimise the risk of infection
• Clinical staff were up to date with their continuing professional development
• Patients’ needs were assessed and treatment was planned and delivered in line with best practice guidance such as from the National Institute for Health and Care Excellence
• The practice had appropriate equipment and medicines to respond to a medical emergency in line with British National Formulary guidance
• There was lack of effective processes in place to ensure patients were safeguarded from the risks of abuse.
• The practice did not have processes in place such as undertaking audits and obtaining staff feedback to assess and monitor the quality of the service.
• The practice did not have effective systems to safely recruit staff members.
• The practice did not have appropriate arrangements in place to ensure that X-rays were taken safely and in line with health and safety requirements.
• The practice was not carrying out risk assessments to ensure the health and safety of staff and patients.

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

• Ensure that the practice is in compliance with its legal obligations under Ionising Radiation Regulations (IRR) 99 and Ionising Radiation (Medical Exposure) Regulation (IRMER) 2000.

• Ensure that systems and processes are established and operated effectively to prevent abuse of service users.

• Ensure the practice's recruitment policy and procedures are suitable and the recruitment arrangements are in line with Schedule 3 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 that appropriate governance arrangements are in place for the safe running of the service.

• Ensure there are systems in place to monitor and assess the quality of the service.

• Ensure audits are undertaken at regular intervals. The provider must also ensure that all audits have learning points documented and resulting improvements can be demonstrated.

• Ensure that the registered person establishes and operates effectively an accessible system for identifying, receiving, recording, handling and responding to complaints by service users.

You can see full details of the regulations not being met at the end of this report.

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

• Ensure all staff are aware of their responsibilities under the Mental Capacity Act (MCA) 2005 as it relates to their role.

• Ensure that all necessary equipment is available to staff for the appropriate decontamination of used dental instruments including an illuminated magnifying glass to examine instruments.