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 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

St Clements City Dental Care is in Farringdon, London. The practice provides private treatment to adults and children.

There is level access for people who use wheelchairs and those with pushchairs.

The dental team includes three dentists, three trainee dental nurses, and a practice manager. The dental nurses and manager undertake receptionist duties. The practice has three treatment rooms.

The practice is owned by a company and as a condition of registration must have a person registered with the CQC 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. The registered manager at St Clements City Dental Care is the principal dentist.

On the day of inspection, we collected 20 CQC comment cards filled in by patients.

During the inspection we spoke with two dentists, three dental nurses, and the practice manager. We checked practice policies and procedures and other records about how the service is managed.

The practice is open at the following times:

Monday to Thursday: 9am-8pm

Friday: 9am-5pm

Our key findings were:

• The practice appeared clean and well maintained.
• Staff knew how to deal with emergencies.
• The clinical staff provided patients’ care and treatment in line with current guidelines.
• Staff were providing preventive care and supporting patients to ensure better oral health.
• The appointment system took account of patients’ needs.
• The provider had suitable information governance arrangements.
• Staff felt involved and supported.
• The provider asked staff and patients for feedback about the services they provided.
• Staff treated patients with dignity and respect.
• The provider had not established effective systems for managing incidents.
• The provider had not established effective governance systems to help them manage risks to patients and staff in relation to staff recruitment and training procedures, carrying out clinical audits, and managing complaints. They had not provided staff with sufficient information relating to reporting safeguarding concerns, making notifications to the CQC. They had not identified risks relating to the lack of some emergency equipment.
• The provider had not established a suitable protocol for monitoring outgoing referrals.
• The provider had arrangements for patients with enhanced needs, such as wheelchair users, though they had not carried out a Disability Access audit.
• The provider had infection control procedures which reflected published guidance except in relation to rinsing of instruments.
• The provider had not suitably maintained equipment and the premises relating to electrical safety, dental implants, fire safety and air conditioning.
• The provider carried out a fire risk assessment but we found it was not effective.
• The provider had carried out a Legionella Risk assessment but had not implemented actions in response to identified risks.
• The risk assessments for the Control of Substances Hazardous to Health (COSHH) required updating.

We identified regulations the provider was not complying with. They must:

• Ensure care and treatment is provided in a safe way to patients.
• Ensure there is an effective system for identifying, receiving, recording, handling and responding to complaints by patients and other persons in relation to the carrying on of the regulated activity.
• 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.

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

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

• Review the practice’s protocols for referral of patients and ensure all referrals are monitored suitably.
• Review its responsibilities to respond to meet the needs of patients with disability and the requirements of the Equality Act 2010, in line with a Disability Access audit:
• Review the practice’s infection control procedures and protocols in relation to the rinsing of cleaned instruments, to take into account guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices and have regard to The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance’.
• Review their responsibilities as regards the COSHH Regulations 2002 and ensure all documentation is up to date and organised in such a way as to facilitate access for staff.

We carried out an announced comprehensive inspection on 10 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 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 providing well-led care in accordance with the relevant regulations.

St Clements Dental Care is located in the London Borough of Islington. The practice is on three floors and comprises of three surgeries and a decontamination room. There is also a reception and waiting area. Toilet facilities and a staff area where also available.

The practice provides private dental services and treats both adults and children. The practice offers a range of dental services including routine examinations and treatment.

The staff structure of the practice comprises of a principal dentist, two associate dentists, four dental nurses and a practice manager. The practice was open Monday to Thursday from 9am-8pm and Friday from 9am-5pm.

St Clements City Dental Care is registered with the Care Quality Commission (CQC) as an organisation. The principal dentist is the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. 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 inspection took place over one day and was carried out by a CQC inspector and a dental specialist advisor.

We received feedback from 37 patients. The feedback from the patients was positive in relation to the care they received from the practice. They were complimentary about the friendly and caring attitude of the staff.

Our key findings were:

• Patients’ needs were assessed and care was planned in line with best practice guidance, such as from the National Institute for Health and Care Excellence (NICE).
• The practice had systems in place to minimise the risks associated with providing dental services.
• The practice had policies and procedures in place for child protection and safeguarding adults.
• Equipment, such as the air compressor, autoclave (steriliser), and dental chair had all been checked for effectiveness and had been regularly serviced.
• There were systems in place to reduce the risk and spread of infection.
• Staff did not have access to an automated external defibrillator (AED) in line with current guidance and had not undertaken and documented a risk assessment as regards its absence.
• Patients indicated that they felt they were listened to and that they received good care from a helpful and patient practice team.
• There were arrangements in place to deal with foreseeable emergencies
• There was a complaints procedure available for patients.
• The practice had a clear management structure and governance arrangements were in place for the smooth running of the practice.

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

• Review its audit protocols to ensure audits of various aspects of the service, such as radiography and dental care records are undertaken at regular intervals to help improve the quality of service. Practice should also ensure that where applicable audits have documented learning points and the resulting improvements can be demonstrated.
• 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 availability of equipment 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. Document checks carried out on emergency equipment. Review the system for storing and tracking prescription pads.
• Review the storage of dental care products and medicines requiring refrigeration to ensure they are stored in line with the manufacturer’s guidance and the fridge temperature is monitored and recorded.

• Review the processes and systems in place for seeking and learning from patient feedback with a view to monitoring and improving the quality of the service.