We carried out an announced comprehensive inspection of this service on 04 June 2015 as part of our regulatory functions. A 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.

We undertook this focused inspection on 08 September 2015 to check that they had followed their plan and to confirm that they now met legal requirements. 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 Karia Dental - Welling on our website at www.cqc.org.uk.

We carried out an announced comprehensive inspection on 04 June 2015 to ask the practice the following key questions; Are services safe, effective, caring, responsive and well-led?

Karia Dental – Welling is located in the London Borough of Bexley. The premises consist of seven treatment rooms, two dedicated decontamination areas and an X-ray room. There are also toilet facilities, a waiting room, a reception area and an administrative office.

The practice provides NHS and private dental services and treats both adults and children. The practice offers a range of dental services including routine examinations and treatment, veneers, crowns and bridges, tooth whitening and oral hygiene.

The staff structure of the practice is comprised of a principal dentist (who is also the owner), eight dentists, seven dental nurses, three hygienists, a practice manager, three receptionists, and one trainee dental nurse. There is also a visiting oral surgeon providing treatment at the practice.

The practice is open Monday to Friday from 8.00am to 5.30pm and on Saturday from 9.00am to 1.00pm.

The principal dentist is the registered manager. A registered manager is a person who is registered with the Care Quality Commission (CQC) 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.

This practice was last inspected by CQC in April 2012 and met the required standards at that time. We carried out a new, announced, comprehensive inspection on 04 June 2015. The inspection took place over one day and was carried out by a CQC inspector and dentist specialist advisor.

We received 25 CQC comment cards completed by patients and spoke with two patients in the waiting area. Patients we spoke with, and those who completed comment cards, were positive about the care they received from the practice. They were complimentary about the friendly and caring attitude of the dental staff.

We found that this practice was providing safe, effective, caring, and responsive care in accordance with the relevant regulations. However we found that this practice was not providing well-led care in accordance with the relevant regulations.

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).

• Equipment, such as the air compressor, autoclave (steriliser), fire extinguishers, oxygen cylinder and X-ray equipment had all been checked for effectiveness and had been regularly serviced.

• The practice ensured staff maintained the necessary skills and competence to support the needs of patients.

• Patients indicated that they felt they were listened to and that they received good care in a from a helpful and patient practice team.

• The practice had implemented clear procedures for managing comments, concerns or complaints.

• The principal dentists had a clear vision for the practice and staff told us they were well supported by the management team.

• We also found that the governance arrangements and audits were not effective in improving the quality and safety of the services

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

• Review governance arrangements including the effective use of risk assessments, audits, such as those for infection control, and staff meetings for monitoring and improving the quality of the care received.

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 suitability of all areas where decontamination of used dental instruments is undertaken, and the fixtures and fittings in the treatment rooms giving due regard to guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices.

• Ensure all staff including the domestic staff have received training in infection control processes.

• Review the arrangements for the storage of emergency medicines to reduce the risk that they can be accessed inappropriately by members of the public.

People told us that they were provided with clear information about treatment options and the cost of treatments that enabled them to make informed decisions. They told us that staff were “pleasant and nice”.

People told us that the dentists listened to them and talked through all the possible treatment options. They said that they were satisfied with the information, care and treatment provided by dentist and other staff.

They told us that the staff were polite and that appointments were flexible to meet their needs.