We carried out an announced follow-up inspection at Linden Lodge Dental Practice on the 25 August 2017. This followed an announced comprehensive inspection on the 19 December 2016 carried out as part of our regulatory functions where breaches of legal requirements were found.

After the comprehensive inspection, the practice wrote to us to say what actions they would take to meet the legal requirements in relation to the breaches.

We revisited Linden Lodge Dental Practice and checked whether they had followed their action plan.

The practice had been served a requirement notice for issues relating to the key question of well led. We reviewed the practice against this key question which they were in breach of. We also reviewed the key question of safe as we had made recommendations and the provider had made improvements in this area. This report covers our findings in these two areas.

You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Linden Lodge Dental Practice 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 led by a CQC inspector and a specialist dental advisor.

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, audits, policies and staff training records.

Our key findings were:

• Appropriate medicines and life-saving equipment were available. Logs of checks to equipment were being maintained.
• Safeguarding policies and procedures were in place and had relevant contact details for the local authority.
• The practice had systems to help them manage risk. Governance arrangements were in place for effective and smooth running of the practice
• There was effective leadership at the practice and systems were in place to share information and learning amongst the team.

We carried out an announced comprehensive inspection on 19 December 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 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

Linden Lodge Dental Practice is a NHS dental practice in Croydon. The practice is situated in purpose built premises. The practice is set out over one floor and has two dental treatment rooms, a patient waiting room, a staff room, two offices and a decontamination room. They were also in the process of developing a third surgery.

The practice is open 9.00am to 5.30pm Monday to Fridays and 9.00am to 1.30pm on Saturdays. The practice has two principal dentists, three associate dentists, two dental nurses, one trainee dental nurse, three receptionists and a dental hygienist.

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.

Before the inspection we sent Care Quality Commission comment cards to the practice for patients to complete to tell us about their experience of the practice. We received feedback from 18 patients via completed comment cards. Patients provided a positive view of the services the practice provides. They commented on the quality of care, the friendliness and professionalism of all staff, the cleanliness of the practice and the overall quality of customer care.

Our key findings were:

• Staff had been trained to handle emergencies and appropriate medicines and some life-saving equipment was readily available. The practice did not have access to a defibrillator.
• The practice appeared clean and well maintained.
• Infection control procedures were adequate; however audits were not being completed periodically.
• The practice had a safeguarding lead. However information relating to safeguarding was out of date and did not have correct contact numbers.
• The practice had a system in place for reporting incidents which the practice used for shared learning.
• Dentists provided dental care in accordance with current professional and National Institute for Health and Care Excellence (NICE) guidelines.
• The service was aware of the needs of the local population and took these into account in how the practice was run.
• Patients could access treatment and urgent and emergency care when required.
• Staff recruitment records included relevant pre recruitment documents such as criminal records checks and proof of ID verification.
• There was lack of a structured approach to learning and development. Staff arranged most training on their own.
• Staff we spoke with felt well supported by the practice owners and were committed to providing a quality service to their patients.
• Feedback from patients gave us a positive picture of a friendly, caring, professional and high quality service.
• Governance arrangements were in place for the smooth running of the practice; however the practice did not have a structured plan in place to carry out risk assessments and assess and mitigate risks arising from undertaking of the regulated activities, have regular staff meetings or a structured approach to staff learning development. There was lack of a structured system in place for carrying out infection control or radiography audits, although we were told the practice audited these areas periodically

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

• Ensure suitable governance arrangements are in place and an effective system is established to assess, monitor and mitigate the various risks arising from undertaking of the regulated activities.
• Ensure systems are in place to assess, monitor and improve the quality of the service. These could include for example undertaking regular audits of various aspects of the service. Provider should also ensure that where appropriate audits have documented learning points and the resulting improvements can be demonstrated.

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

• Review the practice's policy and the storage of products identified under Control of Substances Hazardous to Health (COSHH) 2002 Regulations to ensure a risk assessment is undertaken and the products are stored securely.
• 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.

Patients using the service were given information about their treatment and were able to make informed choices. Dental status was assessed and treatment advice given in accordance with clinical needs and patient wishes, and risks and benefits of treatment were clearly explained. Patients were able to discuss different options and ask questions. Equality and diversity had been considered and there were disabled facilities. There were suitable arrangements for emergencies. Staff had regular training in basic life support and first aid.

The patients we spoke with were happy about the care and treatment they had received. One patient told us, “I’m very satisfied, the treatment here is of very good quality.” Another said, “They are very gentle and explain everything they are doing.”

There were policies and procedures to provide guidance for staff on child protection and safeguarding of vulnerable adults from abuse.

The premises were clean and adequate standards of hygiene and cleanliness were apparent. Infection control policies and procedures were in place to minimise the risk of infection to patients and staff and there were appropriate decontamination processes.

The provider did not have evidence of an effective recruitment process.

There were measures in place to monitor and assess the quality of the service. There was a patient satisfaction questionnaire which was analysed regularly and showed high levels of satisfaction with the service.