We carried out an unannounced focused inspection on 20 April 2016 to follow up on previous inspections carried out on 8 October 2015 to ask the practice the following key questions; Are services safe, effective, 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 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 providing well-led care in accordance with the relevant regulations

Background

We inspected the practice on 08 October 2015 and asked the provider to make improvements regarding Regulation 12 HSCA (RA) Regulations 2014 Safe care and treatment, Regulation 18 HSCA (RA) Staffing and Regulation 17 HSCA (RA) Regulations 2014 Good governance. We checked these breaches as part of the focused inspection on 20 April 2016.

Healthcare Elite provides private dental treatment from their clinic in Gravesend Kent. The dental treatment provided is general and cosmetic dentistry. The practice mostly provides treatment for adults but has a small number of patients that are children.

Practice staffing consist of the principal dentist who is also the owner a registered manager who is the practice manager, two dentists, two dental nurses (one qualified and one student, and a hygienist. 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 practice opening hours are 9am to 5pm Monday, Wednesday and Thursday

9am to 8pm Tuesday, 9am to 4pm Friday and 9am to 1pm Saturdays.

Our key findings were:

• The practice had systems and processes to monitor the safe management of medicines and materials
• The practice had implemented systems to ensure that out of date and expired instruments and materials were re-processed and/or disposed of.
• The practice had carried out audits in key areas, such as infection control, record keeping and the quality of X-rays.
• There were systems in place to check all equipment had been serviced and maintained regularly, including the steriliser and the X-ray equipment.
• Dental care records were consistent and contained accurate information of the treatments provided to patients.
• Staff followed the appropriate decontamination process of instruments according to national guidelines. And monitored all aspects of the infection control procedures.
• Staff had received further training appropriate to their roles and were supported in their continued professional development (CPD).

We carried out an announced comprehensive inspection on 08 October 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 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 not 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

HealthCare Elite provides both private general dentistry and cosmetic dentistry to patients in Gravesend, Kent and the surrounding areas.

The practice staff included three dentists, a hygienist, two dental nurses (one trained and one trainee) and a practice manager. Dental services are provided Monday, Wednesday and Thursday from 9am to 5pm, Tuesday from 9am to 8pm, Friday from 9am to 4pm and Saturday from 9am to 1pm.

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.

Seven patients commented on the dental practice and all comments were positive about the service patients experienced at HealthCare Elite. Patients indicated that they felt the practice offered an excellent service and staff were professional, helpful and kind. They said that staff treated patients with dignity and respect. Patients had sufficient time during consultations with staff and felt listened to as well as safe.

Our key findings were:

• There were systems to check equipment had been serviced regularly, including the compressor, autoclave and the X-ray equipment.
• Staff recruitment files contained evidence that all appropriate checks were carried out on staff prior to their employment at HealthCare Elite. Management of clinical waste segregation was good. Patient dental care records demonstrated that an examination of the patient’s oral health was not always completed prior to treatment being carried out
• Patients were provided with information and were involved in decision making about the care and treatment they received.
• There was a leadership structure with named staff in lead roles

• The practice had a monitoring system to help ensure staff maintained their professional registration.

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

• Improve the content and quality of dental care records in line with national guidance.
• Revise radiography quality assurance processes to ensure that poor quality images are below 10% in line with current legislation.
• Ensure systems are introduced for the proper and safe management of medicines.
• Ensure the practice has an effective system to assess, monitor and mitigate the risks arising from infection control associated hazards, and spread of infection.
• Ensure that all sterile equipment is within it’s expiry date and is fit for purpose.
• Ensure that there are appropriate governance arrangements for the safe running of the service by establishing systems to monitor and assess the quality of the service.
• Ensure that staff receive appropriate training in order for them to carry out their role within the practice in a knowlegable, safe and effective manner.

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

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes.

Patients told us they were consulted regarding their treatment and that all options were explained to them including the various treatment costs before treatment commenced. They also said that their dentist was very thorough in making assessments and asked them various questions relating to their current health status.

We saw that children and adults who used the service were protected from the risk of abuse because the provider had procedures in place to identify the risk of abuse and to prevent abuse from happening.

The provider had effective systems in place to regularly assess and monitor the quality of service that people received.