We carried out a follow- up inspection on 13 October 2016 at Tan Dental Practice.

We had undertaken an announced comprehensive inspection of this service on 10 June 2015 as part of our regulatory functions where 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. This report only covers our findings in relation to those requirements.

We reviewed the practice against two of the five questions we ask about services: is the service safe and well-led?

We revisited Tan Dental Practice as part of this review and checked whether they had followed their action plan

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

We carried out an announced comprehensive inspection on 10 June 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 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.

Tan Dental Practice is situated in Tottenham High Road, London. It offers NHS and private dental care services to patients of all ages. The services provided include preventative advice and treatment and routine and restorative dental care. Treatment and waiting rooms are on the ground floor of the premises.

The practice has one full time dentist, one part time dentist, two dental nurses and a receptionist. The principal dentist takes on the practice management role. The practice is open Monday to Friday from 9-00am to 5-30pm with extended opening on a Thursday to 6.30pm.

We spoke with four patients who used the service on the day of our inspection and reviewed 28 completed CQC comment cards. Patients we spoke with and those who completed comment cards were positive about the care they received from the practice. They commented they had no difficulties in arranging a convenient appointment and staff were caring, helpful and respectful.

Our key findings were:

• The practice had safe systems in place for infection prevention and control and for the decontamination of dental instruments.

• Staff received training appropriate to their roles and told us they felt well supported to carry out their work.

• Patients told us they were treated with kindness and respect by staff. Staff ensured there was sufficient time to explain fully the care and treatment they were providing in a way patients understood. Patients commented they felt involved in their treatment and that it was fully explained to them.

• Patients were able to make routine and emergency appointments when needed. There were clear instructions for patients regarding out of hours care.

• There were limited governance arrangements in place to guide the management of the practice.

• The practice did not have effective systems in place to assess, monitor and mitigate the risks relating to the health, safety and welfare of patients, staff and visitors.

• The practice did not undertake documentation of care records in line with current best practice guidance for example from the Faculty of General Dental Practice (FGDP).

• All necessary equipment required for the management of medical emergencies was not available.

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

• 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.

• Establish suitable recruitment policy and procedures and ensure 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.

• Establish an effective system to assess, monitor and mitigate the risks relating to the health, safety and welfare of patients, staff and visitors.

• 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.

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

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

• Review the practice’s protocols for the use of rubber dam for root canal treatment giving due regard to guidelines issued by the British Endodontic Society.

• Ensure all policies and procedures documents are in place and up to date to ensure the practice is run effectively.