We carried out a follow- up inspection on 26 April 2017 at Smile A Moment

We had undertaken an unannounced follow-up inspection of this service on 09 March 2016 as part of our regulatory functions where breach of legal requirements was found.

After the follow up inspection, the practice wrote to us to say what they would do to meet the legal requirements in relation to the breach.

We revisited Smile A Moment as part of this review and checked whether they had followed their action plan.

We reviewed the practice against two of the five questions we ask about services: is the service safe and well-led? This report only covers our findings in relation to those requirements.

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

Background

This inspection was planned to check whether the practice was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The follow up inspection was led by a CQC inspector who had access to remoteadvice from a specialist advisor.

During our inspection visit, we checked that points described in the provider’s action plan had been implemented by looking at a range of documents such as risk assessments, staff files, policies, procedures and staff training. We also carried out a tour of the premises.

Our key findings were:

• The practice had infection control procedures which reflected published guidance.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• The practice had systems to help them manage risk.
• The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• The practice had thorough staff recruitment procedures.
• The clinical staff provided patients’ care and treatment in line with current guidelines.
• The practice had effective leadership. Staff felt involved and supported and worked well as a team.
• The practice asked staff and patients for feedback about the services they provided.

Smile A Moment Studio is located in the London Borough of Islington and provides private treatment to both adults and children. We carried out an announced comprehensive inspection of this service on 01 December 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 09 March 2016 and revisited Smile A Moment Studio as part of this review 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.

The practice did not have policies and procedures in place for safeguarding adults and child protection. The practice did not have a fire safety policy, an evacuation procedure, fire exit signs and sufficient fire extinguishers. The practice was using locum dental nurses for the past two years but there was no evidence that the relevant employment checks had been carried out. The principal dentist was carrying out treatment without the support of a dental nurse which was not in line with GDC guidance Standards for the Dental Team.

You can read the report from our last comprehensive inspection by selecting the 'all reports' link for Smile A Moment Studio on our website at www.cqc.org.uk.

We carried out an announced comprehensive inspection on 01 December 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.

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

Smile A Moment Studio is located in the London Borough of Islington and provides private treatment to both adults and children. The premises are on the ground floor and consist of one surgery, a reception area and a decontamination room. The demographic of the practice is mixed and serves patients from different social and ethnic backgrounds. The practice is open Monday to Friday at various times including one late evening.

The staff consists of the principal dentist, one associate and a receptionist. The practice uses locum dental nurses from different recruitment agencies. At the time of our inspection the practice did not have a Registered Manager. 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 received eight Care Quality Commission (CQC) comment cards completed by patients. Patients who completed the comment cards were positive about the service. They were complimentary about the friendly and caring attitude of the staff.

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

Our key findings were:

• Patients’ needs were assessed and care was planned in line with current guidance.
• Patients were involved in their care and treatment planning so they could make informed decisions.
• There were effective processes in place to reduce and minimise the risk and spread of infection; however improvements were required in relation to following current infection control guidance.
• We found the dentists regularly assessed each patient’s gum health and took X-rays at appropriate intervals.

• Patients were treated with dignity and respect and confidentiality was maintained.
• The appointment system met the needs of patients and waiting times were kept to a minimum
• There were insufficient numbers of suitably qualified, competent, skilled and experienced persons deployed in order to meet the requirements of the regulations.
• Governance arrangements in place were not effective to facilitate the smooth running of the service and there was no evidence of audits being used for continuous improvements.

• The practice did not have a structured plan in place to assess various risks arising from undertaking the regulated activities.
• There was lack of appropriate systems in place to safeguard patients
• Records as are necessary to be kept in relation to persons employed in the carrying on of the regulated activity, and the management of the regulated activity were not maintained suitably and securely.

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

• Ensure that the equipment used by the service provider for providing care or treatment to a service user is safe for such use and is used in a safe way.

• Ensure that the practice has and implements, robust procedures and processes that make sure that people are protected from abuse.

• Ensure the practice's recruitment policy and procedures are suitable and the recruitment arrangements are in line with Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 to ensure necessary employment checks are in place for all staff and the required specified information in respect of persons employed by the practice is held.

• Ensure sufficient numbers of suitably qualified, competent, skilled and experienced persons are deployed in order to meet the requirements of the regulations.

• Ensure the training, learning and development needs of individual staff members are reviewed at appropriate intervals and an effective process is established for the on-going assessment and supervision of all staff.

• Ensure the practice establishes an effective system to assess, monitor and mitigate the various risks arising from undertaking of the regulated activities.

• 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 check all audits have documented learning points and the resulting improvements can be demonstrated.

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

• Review the practice’s system for recording, investigating and reviewing incidents or significant events with a view to preventing further occurrences and ensuring that improvements are made as a

• Review the practice’s sharps procedures giving due regard to the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.