We carried out this announced inspection on 12 March under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We planned the inspection to check whether the registered provider was meeting the legal requirements in the Health and Social Care Act 2008 and associated regulations. The inspection was led by a CQC inspector who was supported by a specialist dental adviser.

To get to the heart of patients’ experiences of care and treatment, we always ask the following five questions:

• Is it safe?

• Is it effective?

• Is it caring?

• Is it responsive to people’s needs?

• Is it well-led?

These questions form the framework for the areas we look at during the inspection.

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

J U Shah is in the London Borough of Harrow. The practice provides NHS and private treatments to patients of all ages.

The practice is located on the first floor above a row of shops and is situated close to public transport bus services.

The dental team includes the principal dentist who owns the practice and one dental nurse/receptionist

The practice is owned by an individual who is the principal dentist there. They have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run.

On the day of inspection, we received feedback from 15 patients.

During the inspection we spoke with the principal dentist and the dental nurse.

We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday to Friday from 9am to 5.30pm.

Our key findings were:

• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• The provider had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• The appointment system met patients’ needs.
• The practice had thorough staff recruitment procedures.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• Not all areas of the premises were suitably maintained.
• The practice infection control procedures did not reflect published guidance. Infection control audits were only carried out annually. Single-use items were being reused.
• Risks arising from fire and Legionella had not been suitably identified and mitigated.
• The clinical staff did not provide patients’ care and treatment in line with current guidelines.
• The practice was not providing preventive care and supporting patients to ensure better oral health.
• There was ineffective leadership and a lack of clinical and managerial oversight for the day-to-day running of the service.
• The practice did not have suitable information governance arrangements.

We identified regulations the provider was not meeting. They must:

• Ensure care and treatment is provided in a safe way to patients.

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

We spoke to one patient using the service who told us their treatment was always explained to them and “it is always clear about the costs involved and a choice of payment options is always available”.

We observed staff following best practice guidelines for surgical instrument decontamination and hygiene. Staff had been trained in infection control and dealing with emergencies to protect patients from risk of harm.

Staff had been trained on safeguarding. The staff received appropriate support at work and we found staff were qualified to carry out their work and training had been undertaken in line with their professional development requirements.

A complaint policy and procedure was available for patients to use if they wanted to raise a concern. One patient told us they had “no complaints”. We found that all the patients who responded to a patient satisfaction survey said they were aware of the complaint procedure at the practice.