We carried out a follow- up inspection of this service on 29 June 2017.

We had undertaken a focused inspection of this service on 20 March 2017 as part of our regulatory functions where breach of legal requirements was found.

After the focused inspection, the practice wrote to us to say what they would do to meet the legal requirements in relation to the breach. This report only covers our findings in relation to those requirements.

We reviewed the practice against one of the five questions we ask about services: is the service well-led?

We revisited the surgery as part of this review and checked whether they had followed their action plan.

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

We carried out a follow- up inspection of this service on 20 March 2017.

We had undertaken an unannounced comprehensive inspection of this service on 18 October 2016 as part of our regulatory functions where breach of legal requirements was 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. This report only covers our findings in relation to those requirements.

We reviewed the practice against three of the five questions we ask about services: is the service safe, effective and well-led?

We revisited the surgery as part of this review and checked whether they had followed their action plan.

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

We carried out an unannounced comprehensive inspection on 18 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 not providing safe care in accordance with the relevant regulations.

Are services effective?

We found that this practice was not 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

Diamond Dental and Medical Clinic is located in the London Borough of Barnet and provides private dental treatment to both adults and children. The premises are on the ground floor and consist of four treatment rooms, an X-ray room, a reception area and a dedicated decontamination room. The practice is open Monday to Sunday 9:00am – 9:00pm.

The staff consists of two associate dentists and the practice manager.

The practice manager 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.

Our key findings were:

• The practice had effective safeguarding processes in place and staff understood their responsibilities for safeguarding adults and child protection.
• Patients were treated with dignity and respect and confidentiality was maintained.
• The practice had implemented clear procedures for managing comments, concerns or complaints.

• Patients had good access to appointments, including emergency appointments, which were available on the same day.

• There were ineffective processes in place to reduce and minimise the risk and spread of infection.

• Recruitment checks were not undertaken suitably.

• Patients’ needs were not assessed and care was not planned in line with current guidance such as from the National Institute for Health and Care Excellence (NICE).
• We found the dentists did not regularly assess each patient’s gum health and took X-rays at appropriate intervals.
• Patients were not involved in their care and treatment planning so they could make informed decisions..
• Leadership structures were unclear and there were no processes in place for dissemination of information and feedback to staff.
• The registered manager was not aware of their responsibilities under the Duty of Candour.

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

• Ensure the practice’s infection control procedures and protocols are suitable 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’.
• 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 the training, learning and development needs of individual staff members are reviewed at appropriate intervals and an effective process is established for the on-going assessment and supervision of all staff.
• Ensure audits of various aspects of the service, such as radiography, infection control and dental care records are undertaken at regular intervals to help improve the quality of service. The practice should also check that where applicable audits have documented learning points and the resulting improvements can be demonstrated.
• Ensure the practice undertakes a Legionella risk assessment and implements the required actions 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 the current staffing arrangements are appropriate and the dentists are adequately supported by a trained member of the dental team when treating patients in a dental setting.
• Ensure current policies and procedures for obtaining patient consent to care and treatment reflect current legislation and guidance, and that staff follow them at all times.

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

• Review the practice protocol and ensure staff are aware of their responsibilities as per the Duty of candour under The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
• Review availability of equipment to manage medical emergencies taking into account guidelines issued by the Resuscitation Council (UK), and the General Dental Council (GDC) standards for the dental team.
• 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 protocols for the use of rubber dam for root canal treatment taking into account guidelines issued by the British Endodontic Society.

• 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 storage of records related to people employed and the management of regulated activities taking into account current legislation and guidance.

• Review the practice's protocols for completion of dental records taking into account guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.
• Review staff awareness of the requirements of the Mental Capacity Act (MCA) 2005 and ensure all staff are aware of their responsibilities under the Act as it relates to their role.