We carried out this announced inspection on 11 March 2019 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 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

Oracare Dental Practice in the London Borough of Harrow. The practice provides predominantly private treatments and limited NHS treatment to patients of all ages.

The practice is situated close to public transport bus services.

The dental team includes the principal dentist who owns the practice, one associate dentist, three dental nurses, one trainee dental nurse and a 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 including patents we spoke with during the inspection.

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

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

The practice is open:

Monday 9.30am to 2pm

Wednesday to Saturday 9.30am to 5pm

Our key findings were:

• Staff treated patients with dignity and respect and took care to protect their privacy.
• The appointment system met patients’ needs.
• The practice appeared clean and well maintained.
• The practice had arrangements to deal with complaints positively and efficiently.
• The practice asked patients for feedback about the services they provided
• The practice safeguarding policies was up to date, there was information to assist staff on how to report concerns to the local safeguarding agencies
• The practice had infection control procedures which reflected published guidance.
• Dental unit waterlines were disinfected as per national guidelines though further improvements were needed as a Legionella risk assessment had not been carried out.
• Staff knew how to deal with emergencies. Improvements were needed so that the recommended emergency medicines and life-saving equipment were available.
• We saw records confirming the servicing, maintenance and regular checks of equipment and appliances. Improvements were required as the electrical five-year fixed wire safety certificate had not been obtained. The provider sent evidence to show this had been booked to take place in the next few days.
• Radiography and Infection control audits were not carried out in accordance with current guidelines.
• 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 were not able to speak with anyone using the service because no patients were present during our visit. We gathered evidence of people's experiences of the service from comments made on the service's satisfaction questionnaires. The service took up any suggestions from the surveys, for example for the dental hygienist to work additional days.

People expressed their views and were involved in making decisions about their care and treatment. The patient notes that we saw included discussion of treatments and advice on the charges. Patients signed consent forms for their treatment. Most of the patients who used the service were of Chinese origin, and the dentist spoke Cantonese and Mandarin. One of the dental nurses spoke Gujarati and Hindi. The staff told us that they ensured that people could understand the information they were given before they signed the consent form.

We saw evidence that staff had attended training on child protection and safeguarding vulnerable adults. The staff we spoke with were able to explain what safeguarding was and how to spot signs of possible abuse.

There were effective systems in place to reduce the risk and spread of infection. The staff carried out daily and weekly audits of the procedures for infection control and equipment was checked regularly to ensure that it was safe.