We carried out an announced follow-up inspection at Derby Road Dental Practice on the 28 June 2017. This followed an announced comprehensive inspection on the 26 October 2016 carried out 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 actions they would take to meet the legal requirements in relation to the breaches.

We revisited Derby Road Dental Practice and checked whether they had followed their action plan.

The practice had been served a requirement notice for issues relating well led. We reviewed the practice against this key question which they were in breach of. However we also reviewed the key questions of safe as the provider had also made some improvements in this area. This report covers our findings in these three areas.

You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Derby Road 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 and a specialist dental 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 such as risk assessments, audits, policies and staff training.

Our key findings were:

• Staff knew how to deal with medical emergencies. Appropriate medicines and life-saving equipment were available. Logs of checks to equipment were being maintained.
• The practice had infection control procedures which reflected published guidance. There were systems in place to ensure that all equipment used to sterilise instruments was being validated as per national guidelines; and maintained as per manufacturer’s recommendations.
• The practice had systems to help them manage risk. Governance arrangements were in place for effective and smooth running of the practice.
• Clinical waste was being segregated and disposed of in accordance with relevant regulations.
• There was effective leadership at the practice and systems were in place to share information and learning amongst the team.

We carried out an announced comprehensive inspection on 26 October 2016 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

Derby Road Dental Practice is a private dental practice in Croydon. The practice is set out over two floors. There is one dental treatment room and a separate decontamination room for cleaning, sterilising and packing dental instruments. In addition there is a reception and waiting area for patients.

The practice is open 9.00am – 6.00pm Monday to Fridays and appointments are available on Tuesday, Wednesday and Fridays during these times.

The practice has one dentist and is supported by a trainee dental nurse (who also provides reception duties).

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.

Before the inspection we sent Care Quality Commission comment cards to the practice for patients to complete to tell us about their experience of the practice. We received feedback from 33 patients. These provided a positive view of the services the practice provides. Patients commented on the quality of care, the friendliness and professionalism of all staff, the cleanliness of the practice and the overall quality of customer care.

Our key findings were:

• We found that the practice ethos was to provide patient centred dental care in a relaxed and friendly environment. Leadership was clear and roles and responsibilities well defined.
• Staff had been trained to handle emergencies and appropriate medicines and life-saving equipment was readily available in accordance with current guidelines.
• The practice appeared clean and well maintained.
• Infection control procedures were in place but published guidance was not being fully followed. Clinical waste was not always being disposed of appropriately.
• The practice had a safeguarding lead with information available to staff to refer to. Staff demonstrated knowledge of safeguarding.
• The practice had a system in place for reporting incidents which the practice used for shared learning.
• Dentists provided dental care in accordance with current professional and National Institute for Health and Care Excellence (NICE) guidelines. However staff did not have up to date training for some procedures they were performing.
• The service was aware of the needs of the local population and took these into account in how the practice was run.
• Patients could access treatment and urgent and emergency care when required.
• The servicing of equipment was not being completed in a timely way.
• Risks associated with undertaking dental procedures under conscious sedation, re-use of single-use instruments such as dental burs and disposal of dental waste had not been recognised and suitably mitigated.

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

• Ensure suitable governance arrangements are in place and an effective system is established to assess, monitor and mitigate the various risks arising from undertaking of the regulated activities.
• Ensure the practice’s protocols for conscious sedation including training requirements are suitable taking into account guidelines published by the Standing Dental Advisory Committee: conscious sedation in the provision of dental care. Report of an expert group on sedation for dentistry. Department of Health 2003.
• Ensure the practice’s infection control procedures and protocols are suitable 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’.
• Ensure waste is segregated and disposed of in accordance with relevant regulations giving due regard to guidance issued in the Health Technical Memorandum 07-01 (HTM 07-01).

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 practice’s protocols for recording in the patients’ dental care records or elsewhere the reason for taking the X-ray and quality of the X-ray giving due regard to the Ionising Radiation (Medical Exposure) Regulations (IRMER) 2000.
• Review the procedures in place for the servicing of equipment ensuring that equipment is serviced at timely intervals.

We spoke with three people using the service on the day of our inspection. People told us staff at the practice were ‘really friendly’ and ‘nice’. One person told us ‘I’m a nervous patient and the dentist is very reassuring’. Another person said ‘I’m impressed with the staff. They remember things about you. You’re not just a patient, you’re a person’. Another person told us ‘’Staff are really good and helpful’.

All the people we spoke with told us the dentist discussed their treatment options with them. One person said ‘The dentist explained everything to me and gave me time to think about what treatment I wanted’. People told us the costs of treatment were always clearly explained to them at each visit.

We looked at the records of people using the service. We saw people had treatment plans which set out their treatment needs and costs.

People we spoke with told us they felt safe when visiting the practice. One person said ‘I feel 100 per cent safe here. I tell everyone to come here’. People also told us the environment was clean and tidy every time they visited.

We saw the provider undertook regular audits to monitor and review the quality and safety of the service provided.