We carried out an announced comprehensive inspection of this service on 23 June 2015 as part of our regulatory functions where 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 carried out a follow- up inspection on 26 April 2016 to check that they had followed their plan and to confirm that they now met the legal requirements. This report only covers our findings in relation to those requirements. We revisited the Norwood Dental Care practice as part of this review.

You can read the report from our last comprehensive inspection by selecting the 'all reports' link for Norwood Dental Care on our website at www.cqc.org.uk.

We carried out an unannounced comprehensive inspection on 23 June 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

Norwood Dental Care is located in the London Borough of Lambeth and is part of the brand Southern Dental that owns a number of dental practices in the South England region. The premises consist of three treatment rooms and one dedicated decontamination room. There are also toilet facilities, a waiting area, a reception area, an administrative office and a staff kitchen area.

The practice provides NHS and private dental services and treats both adults and children. The reception area has a child friendly corner with small chairs, a table and building blocks to occupy young children. The practice offers a range of dental services including routine examinations and treatment and oral hygiene.

The staff structure of the practice is comprised of one dentist, two part-time hygienists, a trainee dental nurse (started on 23 June 2015), one qualified dental nurse, a receptionist and a practice manager (who was on leave).

The practice is open Monday 9:00am to 7:00pm and Tuesday to Friday from 9.00am to 5.00pm. There is one full-time dentist and two part-time hygienists that work on Wednesday 9:00am to 1:00pm and Thursday 9:00am to 5:00pm.

The practice did not have a registered manager in place at the time of our inspection. We were told that the previous practice manager had left a while ago. 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. We have formally requested the provider to send us information as regards the reason for not having a registered manager in place.

We carried out an unannounced comprehensive inspection on 23 June 2015 in response to concerns that were reported to CQC about the essential standards of quality and safety that were not being met.

The inspection took place over one day and was carried out by a CQC inspector and a dentist specialist advisor.

We reviewed four NHS Friends and Family test cards completed by patients and seven reviews posted on the NHS Choices website. Patients gave mixed views about the care and experience of the practice.

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).

• The practice carried out the relevant checks to ensure that the persons being recruited were suitable and competent for the role.

• The practice worked well with other providers and followed patients up to ensure that they received treatment in good time.

• The practice maintained appropriate dental care records and patients’ clinical details were updated appropriately.

• The practice did not have robust arrangements in place to manage single use dental equipment and disposal of clinical waste.

• There were limited governance arrangements in place to guide the management of the practice.

• The practice did not have effective systems in place to assess, monitor and mitigate the risks relating to the health, safety and welfare of patients, staff and visitors.

• The monitoring arrangements and audits were not effective in improving the quality and safety of the services

• The practice had not implemented clear procedures for managing comments, concerns or complaints.

• Appliances and fixtures and fittings in the premises were not being suitably maintained.

• Staff did not receive induction and performance appraisals and there were no training records available to evidence the mandatory training staff had received. Two members of staff we spoke with showed lack of awareness of reporting of safeguarding concerns.

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’
• Ensure waste is segregated and disposed of in accordance with relevant regulations giving due regard to guidance issued in the Health Technical Memorandum 07-01 (HTM 07-01).
• Review the practice’s protocols for undertaking radiography giving due regard to the Ionising Radiation (Medical Exposure) Regulations (IR(ME)R) 2000.

• Establish an effective system to assess, monitor and mitigate the risks relating to the health, safety and welfare of patients, staff and visitors.

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

• Review the suitability of all areas of the premises and the fixtures and fittings in the treatment rooms.

• Ensure all staff receive induction and performance appraisals and are suitably supported in undertaking their activities.

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