We carried out this announced inspection on 1 March 2019 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We planned the inspection in response to concerns we received and 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 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

Rose Lane Dental Surgery is in Romford in the London Borough of Barking and Dagenham. The practice provides predominantly NHS and some private treatments 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. At the time of our inspection the dentist was supported by one receptionist. The practice used an agency for temporary dental nurses.

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 and the receptionist. We also spoke with the temporary dental nurse who was working at the practice.

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

The practice is open:

Monday, Wednesdays and Friday from 9am to 5pm and Tuesdays between 9am and 12pm on Tuesdays (reception only).

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 y 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 had infection control procedures which reflected published guidance.
• Infection control audits were not carried out in accordance with current guidelines.
• There was lack of effective arrangements for dealing with medical emergencies as equipment was not set up ready for use and staff had not completed training updates in basic life support.
• The practice safeguarding policies were not up to date, there was no information to assist staff on how to report concerns to the local safeguarding agencies and staff did not have up to date safeguarding training.
• The practice had limited systems to help them manage risk. There was limited information available in relation to minimising risks associated with hazardous substances. Health and safety risk assessments had not been carried out since 2016.
• The practice had arrangements for the safe use of medicines and equipment. Improvements were needed so that temperature sensitive medicines requiring refrigeration were stored appropriately.
• The practice staff recruitment procedures were not followed so that all of the essential checks were carried out. Improvements were needed to ensure that clinical staff completed the required continuing professional development training.
• The practice was not providing preventive care and supporting patients to ensure better oral health.
• 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.

• Ensure patients are protected from abuse and improper treatment

• 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 and supervision necessary to enable them to carry out the duties.

• Ensure specified information is available regarding each person employed

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

• Review the practice’s protocols for the use of rubber dam for root canal treatment taking into account guidelines issued by the British Endodontic Society.
• Review the practice’s protocols and procedures for promoting the maintenance of good oral health taking into account guidelines issued by the Department of Health publication ‘Delivering better oral health: an evidence-based toolkit for prevention’

We carried out an announced comprehensive inspection of this service on 15 February 2016 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 they would do to meet the legal requirements in relation to the breach.

We carried out a follow- up inspection on 20 July 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 Rose Lane Dental Surgery as part of this review.

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

We carried out an announced comprehensive inspection on 15 February 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 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

Rose Lane Dental Surgery provides NHS and private dental treatment to patients of all ages. The services provided include preventative advice and treatment and routine restorative dental care.

The practice staffing consists of a principal dentist, one dental nurse and a receptionist.

The principal dentist is registered with the Care Quality Commission (CQC) as an individual. 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.

The practice consists of one treatment room, a waiting area for patients and reception area, a staff room, decontamination room and X-ray room.

The practice opening hours are Monday, Wednesday and Friday 9am to 5pm.

Nine patients provided feedback about the service. Patients we spoke with and those who completed comment cards were very positive about the care they received and about the service. Patients told us that they were happy with the dental treatment and advice they had received.

Our key findings were:

• Patients’ care and treatment was planned and delivered in line with current legislation and evidence based guidelines such as from the National Institute for Health and Care Excellence (NICE).
• Staff had received safeguarding children and vulnerable adults training and were aware of the processes to follow to raise any safeguarding concerns.
• There were sufficient numbers of suitably qualified staff to meet the needs of patients.
• Patients were treated with dignity and respect and patient confidentiality was maintained.
• The practice had a procedure for handling and responding to complaints. The practice’s complaints policy was displayed in the waiting area and was available to patients.
• There were systems in place to ensure that equipment including the suction apparatus, compressor unit, autoclave and fire extinguishers had been serviced regularly.
• The practice had no arrangements for receiving and responding to patient safety alerts issued from relevant external agencies.
• Staff had undertaken training in key areas such as infection control and radiography; however there was lack of oversight of staff’s continuing professional development (CPD) activity and it was not being suitably monitored.
• The practice had not ensured that appropriate medicines, in line with British National Formulary and Resuscitation Council (UK) guidance, were available to respond to a medical emergency.
• Infection control protocols were not being followed in line with recommended national guidance.
• The practice had not undertaken a risk assessment in relation to the Control of Substances Hazardous to Health 2002 (COSHH) Regulations.
• Governance systems were not effective. There were a range of policies and procedures in place; however staff had little understanding of the policies with little adaptation to the practice.
• Dental care records were not being suitably completed in line with guidance provided by the Faculty of General Dental Practice.
• The practice had not carried out audits in key areas, such as radiography and infection prevention control (IPC) and record keeping.

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

• Ensure the practice’s infection control procedures and protocols are suitable 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 availability of medicines to manage medical emergencies giving due regard to guidelines issued by the Resuscitation Council (UK), and the General Dental Council (GDC) standards for the dental team.

• Ensure 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.

• Ensure audits of various aspects of the service, such as radiography, infection control and dental care records are undertaken at regular intervals to help improve the quality of service. The practice should also ensure that where appropriate audits have documented learning points and the resulting improvements can be demonstrated.

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

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

• Review the practice's protocols for completion of dental care records giving due regard to guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.
• Review the practice’s arrangements for receiving and responding to patient safety alerts, recalls and rapid response reports issued from the Medicines and Healthcare products Regulatory Agency (MHRA) and through the Central Alerting System (CAS), as well as from other relevant bodies, such as Public Health England (PHE).
• Review staff awareness of the requirements of the Mental Capacity Act (MCA) 2005 and ensure all staff are aware of their responsibilities under the Act as it relates to their role.

• 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.