When we inspected on 17 December 2013, most of the fifty seven patient records we looked at did not include written patient consent. This meant that the provider was failing to comply with the requirements of Regulation 18 of the Health and Social Care Act 2008. We asked the provider to take action and when we inspected again on 3 July 2014 we saw that most of the thirty patient records we looked at included written patient consent.

When we inspected in December 2013, we saw that medication was stored insecurely and the provider did not record daily fridge temperatures. This meant that the provider was failing to comply with the requirements of Regulation 13 of the Health and Social Care Act 2008. At this inspection, we were advised that the provider no longer kept medicines at the location. The medicines fridge contained stocks of medical aesthetic products and emergency drugs. A daily record was also made of the fridge temperature.

When we inspected in December 2013, many records we looked at were not dated and lacked a patient medical history. GP contact details were also missing and there was limited evidence of referrals to specialists. This meant that the provider was failing to comply with the requirements of Regulation 20 (1) (a) of the Health and Social Care Act 2008. At this inspection we saw that, as appropriate, patient records contained medical histories and evidenced timely patient referrals.

Letter from the Chief Inspector of General Practice

We carried out an unannounced comprehensive inspection of Quality Life Medical Centre over two days on 9 and 16 November 2017. This inspection was carried out 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 within the Health and Social Care Act 2008 and associated regulations after identifying concerns in governance arrangements at Quality of Life Medical Centre, a separate location registered to the provider.

We found Quality Life Medical Centre was not providing safe, effective and well led services in accordance with the relevant regulation.

The inspection was led by a CQC inspector who was supported by a second inspector and 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 not 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

Quality Life Medical Centre, also known as House of Smiles Private Dental Clinic, is located in the London Borough of Haringey and provides private treatment to patients of all ages.

There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces, including for patients with disabled badges, are available on public roads, near the practice.

The dental team consists of one dentist and one trainee dental nurse who is a qualified practice nurse in primary health care. The service employs three further dentists on an appointment by appointment basis when certain areas of expertise are required for a patient’s care or treatment. The practice has two treatment rooms although only one of these is currently equipped to carry out treatments. Reception and administrative functions are carried out by the principal dentist and the trainee dental nurse.

The practice is owned by a company and as a condition of registration must have a person registered with the Care Quality Commission as the registered manager. Registered managers have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run. At the time of the first inspection visit, the registered manager at Quality Life Medical Centre was the same person that was the registered manager at Quality of Life Medical Centre. This person did not hold any qualifications in dentistry.

On 10 November 2017, following the inspection at Quality of Life Medical Centre, because of serious concerns, we applied to Haringey Corner Magistrates Court for an urgent order to cancel the registration of the registered manager at Quality of Life Medical Centre and Quality Life Medical Centre. This order was granted under Section 30 of the Health and Social Care Act 2008 and had the effect of cancelling the registration of the registered manager at Quality of Life Medical Centre and Quality Life Medical Centre. On 10 November 2017, the provider was also issued with an urgent Notice of Decision under Section 31 of the Health and Social Care Act 2008 to impose urgent conditions that the registered provider must not carry out any regulated activities at 573 Green Lanes, London, N8 0RL. The provider had the right to make an appeal against this decision to the First-tier Tribunal (Health, Education and Social Care Chamber), under Section 32(1) of the Health and Social Care Act 2008, within 28 days of the date of the notice. The provider did not exercise the right to appeal.

During the first inspection visit, we spoke with person who was the registered manager at the time. We also spoke with the dentist and the trainee dental nurse during both days of the inspection. We looked at practice policies and procedures and other records about how the service is managed.

Our key findings were:

• The registered manager of the service could not demonstrate that they had the experience, capacity or capability to run the service safely or ensure high quality care.
• There was no evidence the service used learning from incidents and complaints to help them improve.
• Safeguarding protocols in place contained incorrect contact information for the local safeguarding authority and staff had not received training in safeguarding children or adults.
• Processes in place to manage infection prevention and control were not effective and staff had not received training around infection control.
• Arrangements in place to manage clinical waste did not keep people safe.
• The practice had a staff recruitment policy and procedure to help them employ suitable staff but records we saw showed that this policy was not always followed.
• There was no evidence that clinical staff had completed the continuous professional development required for their registration with the General Dental Council.
• The provider, of which the service was a registered location, was in breach of Section 42 (1) of the Dentist Act 1984 as the single director of the provider organisation was not a registered dentist or a registered dental care professional.
• The service could not demonstrate how emergencies would be managed. Life-saving equipment had not been checked to ensure it would be ready for use when it was required.
• Systems in place to manage risk were not effective.

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.
• 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.