We carried out this announced inspection on 26 April 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 Care Quality Commission (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

Parkside Dental Practice is in West Wickham, inSouth East London within the London Borough of Bromley. The practiceprovides private treatment to adults and children.

There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces are available at the front of the premises.

The dental team includes two dentists, two dental nurses, a receptionist/administrator, and a dental hygienist. The practice has two treatment rooms.

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 the inspection, we collected 48 CQC comment cards filled in by patients.

During the inspection we spoke with the dentists, a dental nurse, and the receptionist/administrator. We checked practice policies and procedures and other records about how the service is managed.

The practice is open at the following times:

Monday – Friday: 9am – 5.30pm

Saturdays: by arrangement

Our key findings were:

• The practice appeared clean.
• The clinical staff provided patients’ dental care and treatment in line with current guidelines.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• Staff were providing preventive care and supporting patients to ensure better oral health.
• The appointment system took account of patients’ needs.
• Staff felt involved and supported.
• The provider asked staff and patients for feedback about the services they provided.
• The provider dealt with complaints positively and efficiently.
• The provider had infection control procedures. Some dental instruments had not been stored appropriately.
• Staff knew how to deal with medical emergencies. Medicines and life-saving equipment were on the premises, though some were not available, some had been kept past their use-by date, and some were not in line with national guidance.
• The practice had not established effective systems to help them manage risk to patients and staff.
• The provider did not demonstrate that all staff had completed and were up to date with key training such as safeguarding vulnerable adults and children, infection prevention and control, basic life support and fire safety.
• The provider did not have staff recruitment procedures that were in line with current national guidance and legislation.
• Most clinical staff had been immunised, but the provider had not sought assurances that a member of clinical staff had received vaccinations and achieved suitable immunity against Hepatitis B.
• The provider had audited some non-clinical and clinical processes. Improvements were required to have in place an effective system for carrying out regular audits of dental radiography for all relevant dental clinicians, and to ensure they fully completed a Disability Access audit, and a suitable sharps risk assessment.

We identified regulations the provider was not complying with. 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.
• Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out the duties.
• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.

Full details of the regulations the provider was not meeting are at the end of this report.

There were areas where the provider could make improvements. They should:

• Review the provider’s protocols for referral of patients and ensure all referrals are monitored suitably.
• Review the practice’s arrangements in place for environmental cleaning, specifically for bodily fluids.
• Review the fire risk assessment to ensure all identified risks are monitored and mitigated and all actions are completed promptly.