We carried out this follow up inspection on 28 July 2017. This followed an announced comprehensive inspection on 23 March 2017 carried out as part of our regulatory functions, where a breach of a legal requirement was found.

After the comprehensive inspection the practice wrote to us to say what actions they would take to meet legal requirements in relation to the breach.

We revisited Dentcross Kidbrooke Village Dental Surgery and checked whether they had followed their action plan. The practice had been served a requirement notice for issues relating to well led. We reviewed the practice against this key question which they were in breach of.

You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Dentcross Kidbrooke Village Dental Surgery 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 had access to remoteadvice from a specialist advisor.

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 relating to auditing systems to monitor and improve quality of the service provided and the monitoring and mitigation of risks.

Our key findings were:

Auditing systems were in place to monitor and improve quality.

The practice had systems to help them manage risk through the completion of appropriate risk assessments and the monitoring and mitigation of risks identified.

We carried out an announced comprehensive inspection on 23 March 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

Dentcross Kidbrooke Village Dental Surgery is located in the London Borough of Greenwich. The premises are situated in a purpose-built surgery with two treatment rooms, a decontamination room, an X-ray room, a reception and waiting room, patient toilet, staff office and kitchen. The practice is fully wheelchair accessible.

The practice provides NHS and private services to adults and children. The practice offers a range of dental services including routine examinations and treatment, veneers and crowns and bridges.

The staff structure of the practice consists of a principal dentist, a dental nurse and a receptionist.

The practice opening hours are on Mondays to Fridays from 9.00am to 5.30pm.

The principal dentist is 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.

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

Thirty-six people provided feedback about the service. Patients were positive about the care they received from the practice. They were complimentary about the friendly and caring attitude of the dental staff.

Our key findings were:

• Patients’ needs were assessed and care was planned in line with current guidance such as from the National Institute for Health and Care Excellence (NICE).

• There were effective systems in place to reduce and minimise the risk and spread of infection. However, we noted some areas for improvement at the time of the inspection.
• The practice had effective safeguarding processes in place and staff understood their responsibilities for safeguarding adults and children living in vulnerable circumstances.
• Staff knew how to report incidents and kept records of these which the practice used for shared learning.
• There were arrangements in place for managing medical emergencies. However, some medicines had gone past their use by date, and needed replacing, at the time of the inspection.
• Equipment, such as the air compressor, autoclave (steriliser), fire extinguishers, and X-ray equipment had all been checked for effectiveness and had been regularly serviced.
• Patients indicated that they felt they were listened to and that they received good care from a helpful and caring practice team.
• The practice ensured staff maintained the necessary skills and competence to support the needs of patients. However, one member of staff had not had adequate safeguarding training at the time of the inspection.
• The practice had implemented clear procedures for managing comments, concerns or complaints.
• The provider had a clear vision for the practice and staff told us they were well supported by the management team.
• The practice had some governance arrangements and systems to monitor the quality and safety of the service. However, the practice had not effectively monitored and mitigated the risks associated with carrying out the regulated activities.

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

• Ensure systems are in place to assess, monitor and improve the quality of the service such as undertaking regular audits and ensuring that, where appropriate, audits have documented learning points and the resulting improvements can be demonstrated.
• Ensure an effective system is established to assess, monitor and mitigate the various risks arising from undertaking of the regulated activities.

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:

• Review the security of prescription pads in the practice and ensure there are systems in place to monitor and track their use.
• Review stocks of medicines and equipment and the system for identifying and disposing of out-of-date stock.
• Review the practice’s safeguarding training ensuring it covers both children and adults and all staff are trained to an appropriate level for their role and aware of their responsibilities.
• Review the practice’s infection control procedures and protocols taking into account 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 current Legionella risk assessment and implement the required actions including the monitoring and recording of water temperatures, taking into account the 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 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 understand how to minimise risks associated with the use of and handling of these substances.
• Review the practice's protocols for completion of dental records giving due regard to guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.

People who used the service we spoke with told us they were happy with the service they received, and that the dentists provided them with relevant information about their proposed treatment. People told us the information provided was very thorough and the dentist took time to allow them to make decisions about their treatment. One person whose first language was not English commented that the dentist was able to speak with them in their own dialect and always did this when consulting about their treatment.

People told us their privacy and confidentiality was protected by the staff and dentists, and they were always spoken to in a respectful manner. People said that the dentist had always asked them for an update on their health at each visit and had included relevant information in their treatment plan.

The practice treatment rooms were very clean and the dentists’ practices were hygienic. People we spoke with said that the premises were new and were in an excellent state of cleanliness. The premises were wheelchair accessible to ensure access included all patients regardless of disability.

Staff were qualified and had appropriate training and supervision and were supported by the practice to update their training to do their job safely. Staff said they were supported by the dentist in their personal development, and one person had passed their written dental nursing examination with the support of the dentist.