We carried an unannounced focused follow up inspection on 16 August 2017 at Haringey Dentalcare.

We had undertaken an announced comprehensive inspection of this service on 5 August 2015 as part of our regulatory functions where breaches 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 breaches.

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

We reviewed the practice against two of the five questions we ask about services:

• Is it safe?

• Is it 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 Haringey Dentalcare 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 carried out by a CQC inspector who had access to remote advice from a specialist advisor.

We told the NHS England area team that we were inspecting the practice. They provided information which we took into account.

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, policies, procedures and staff training. We also spoke with staff and carried out a tour of the premises.

Our key findings were:

• Systems were in place to assess, monitor and improve the quality of the service.
• The practice had systems to help them manage risk.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• The practice had thorough staff recruitment procedures.
• Equipment was maintained and serviced in line with the manufacturer’s instructions.
• The practice had infection control procedures which reflected published guidance.

We carried out an announced comprehensive inspection on 5 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

Haringey Dentalcare is located in the London Borough of Haringey and provides NHS and private dental services.

The practice team included the principal dentist and a trainee dental nurse.

We reviewed 29 Care Quality Commission (CQC) comment cards completed by patients. We were unable to speak to patients on the day of the inspection as no patients had been booked. The feedback from the patients who completed the CQC comment cards was positive in relation to the care they received from the practice. They commented that staff were caring, respectful and helpful.

Our key findings were:

• Patients’ needs were assessed and care was planned in line with best practice guidance such as from the National Institute for Health and Care Excellence (NICE).
• Staff were knowledgeable about patient confidentiality.
• Patients were able to make routine appointments and emergency appointments when needed.
• The patient comment cards we reviewed indicated that patients were consistently treated with kindness and respect by staff.
• Staff told us they were well supported by the principal dentist.
• The principal dentist ensured consent was obtained before providing treatment
• Risks to patients and staff had not been always been suitably assessed and mitigated
• Staff did not have access to an automated external defibrillator (AED).

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

• 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’.
• Establish an effective system to assess, monitor and mitigate the risks including and not limited to those associated with cleaning of used dental instruments, control of substances hazardous to health, and lack of monitoring of temperature of the fridge used to store dental products.
• Undertake audits of various aspects of the service, such as radiography and dental care records are undertaken at regular intervals to help improve the quality of service. Practice should also ensure all audits have documented learning points and the resulting improvements can be demonstrated.

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

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

• 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.
• Ensure all staff are aware of their responsibilities under the Mental Capacity Act (MCA) 2005 as it relates to their role.
• Ensure staff are up to date with Continuing Professional Development (CPD) recommended by the General Dental Council.

Review the practice’s protocols for the use of rubber dam for root canal treatment giving due regard to guidelines issued by the British Endodontic Society

Review availability of equipment to manage medical emergencies giving due regard to guidelines issued by the Resuscitation Council (UK), and the General Dental Council (GDC) standards for the dental team.

We spoke with seven patients who mostly gave positive feedback about the care and treatment they had received. One patient told us “I am always given a lot of detail. The dentist explains everything to me.”

We observed the provider speaking to patients politely both at the practice and over the telephone and found they were happy to answer questions. We observed that records relating to patients were kept securely ensuring confidentiality. We had some concerns that the provider did not always provide treatment for people in a way that ensured their safety and welfare.

The prevention and control of infection and decontamination of instruments was effectively carried out in accordance with guidance from the Department of Health. Patients we spoke with were generally positive about the cleanliness of the practice telling us "It is always clean when I go there."

We found limited evidence that staff were supported in their professional development however we could not confirm this as we were unable to talk with staff members during or after our inspection. The provider took account of complaints and comments to improve the service.

At our inspection in January 2014 we found that not all treatment was being appropriately planned to ensure people were cared for at all times. We were also concerned that staff were not appropriately supported to carry out their work through appraisals and ongoing training. We asked the provider to take action.

At our May 2014 inspections, we identified through a review of patient record cards that medical histories were being taken and reviewed, regular checks were being carried out and treatment planning was ongoing and people were consulted at all times so that they were aware of work to be carried out and were able to give consent.

We reviewed staff support systems which included minutes of staff meetings, staff appraisals and training records and found all to be up to date and providing the appropriate support to staff members.