We undertook a follow up focused inspection of Vistara Smiles on 16 January 2019.

This inspection was carried out to review in detail the actions taken by the registered provider to improve the quality of care and to confirm that the practice was now meeting legal requirements.

The inspection was led by a CQC inspector.

We had undertaken a comprehensive inspection of Vistara Smiles on 7 June 2018 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We found the registered provider was not providing well led care in accordance with the relevant regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can read our report of that inspection by selecting the 'all reports' link for Vistara Smiles on our website www.cqc.org.uk.

When one or more of the five questions are not met we require the service to make improvements and send us an action plan. We then inspect again after a reasonable interval, focusing on the area where improvement was required.

As part of this inspection we asked:

• Is it well-led?

Our findings were:

Are services well-led?

We found this practice was providing well-led care in accordance with the relevant regulations.

The provider had made improvements in relation to the regulatory breaches we found at our inspection of 7 June 2018.

Background

Vistara Smiles is in Islington, London, and provides private treatment to patients of all ages.

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

The dental team includes two dentists and a trainee dental nurses.

The practice has three treatment rooms.

The practice is open from Monday to Saturday by appointment

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.

Our key findings were:

The provider had made improvements to the management of the service.

The practice had arrangements to ensure the smooth running of the service.

At the previous inspection we had found that this practice was providing safe care in accordance with the relevant regulations but told them there were things they should do. We found that the provider had taken action to address the issues we said they should look at. We found that:

• The practice had a system for the documentation of actions taken and learning shared in response to incidents, with a view to preventing further occurrences and ensuring improvements are made as a result. Staff were aware of the procedures regarding documenting and learning from these events.

• The practice had appropriate infection control procedures and protocols in place that took 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’.

At the previous inspection we had found that this practice was providing effective care in accordance with the relevant regulations but told them there were things they should do. We found that the provider had taken action to address the issues we said they should look at.

We found that:

• The practice had protocols in place for completion of dental care records taking into account guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.

We carried out this announced inspection on 7 June 2018 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 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

Vistara Smiles is in Islington, London, and provides private treatment to patients of all ages.

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

The dental team includes three dentists (one of whom worked on a locum basis), and two trainee dental nurses (both of whom undertake receptionist duties). The practice has three treatment rooms.

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 obtained feedback from 18 patients.

During the inspection we spoke with the principal dentist, and a trainee dental nurse. We checked practice policies and procedures and other records about how the service is managed.

The practice is open from Monday to Saturday by appointment.

Our key findings were:

• The practice appeared clean and well maintained.
• Staff knew how to deal with emergencies.
• Staff knew their responsibilities for safeguarding vulnerable adults and children.
• The clinical staff provided patients’ care and treatment in line with current guidelines.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• The practice was providing preventive care and supporting patients to ensure better oral health.
• The appointment system met patients’ needs.
• Staff felt involved and supported and worked well as a team.
• The practice asked staff and patients for feedback about the services they provided.
• The practice dealt with complaints positively and efficiently.
• The practice had suitable information governance arrangements.

• There was a lack of sufficient equipment to manage medical emergencies.
• Some infection control procedures did not reflect published guidance.
• The practice had not established effective systems to help them manage risk.
• The practice had not established thorough staff recruitment procedures.
• There was a lack of effective processes to ensure all staff had received or updated key training.
• There was a lack of evidence of adequate immunity against vaccine preventable infectious diseases for a member of staff.
• There was a lack of evidence of safety checks of electrical equipment.
• There was a lack of effective systems and processes to ensure good governance.

Shortly after the inspection the practice sent us evidence demonstrating they had begun to take steps to make improvements. We will check improvements have been implemented, sustained and embedded when we carry out a follow-up inspection of the practice.

We identified regulations the provider was not meeting. They must:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

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

• Review the practice's protocols for completion of dental care records taking into account guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.
• Review the practice’s system for managing significant events with a view to ensuring all staff have a good understanding of these, and to ensure a policy is available to provide guidance for staff.
• Review the practice’s infection control procedures and protocols 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’.