We carried out this unannounced inspection on 6 February 2019 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We planned the inspection to follow up on concerns we received and 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

Abbey Dental Walthamstow is in the London Borough of Waltham Forest. The practice provides NHS and private treatment to patients of all ages.

The practice is located on the ground floor of the premises. The layout and design of the building does not offer step free access. The practice is located close to public transport routes including bus and train services.

The dental team includes seven associate dentists, one dental hygienist and six dental nurses. The clinical team are supported by a practice manager and three receptionists.

The practice is owned by a partnership and as a condition of registration must have a person registered with the Care Quality Commission 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 Abbey Dental Walthamstow was the practice manager.

During the inspection we spoke with one associate dentist, the practice manager, three dental nurses and two receptionists. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open between 8am and 6pm on Mondays, Tuesdays and Wednesdays, between 8am and 5pm on Thursdays and between 8am and 4pm on Fridays.

Our key findings were:

• 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.
• 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.
• The practice had arrangements to deal with complaints positively and efficiently.
• The practice had suitable information governance arrangements.
• The practice asked patients for feedback about the services they provided
• Some areas of the practice were not clean or fit for use.
• The practice had infection control procedures which reflected published guidance. Improvements were needed to the arrangements for minimising the risks associated with Legionella.
• Staff knew how to deal with emergencies. Improvements were needed so that the recommended emergency medicines and life-saving equipment were available.
• The practice had systems to help them manage risk. Improvements were needed so that the risks associate with fire were minimised.
• The practice did not have effective leadership. Staff told us that did not feel involved or confident that when they raised issues these would be taken seriously and acted on.

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

• Ensure care and treatment is provided in a safe way to patients.

• Ensure all premises and equipment used by the service provider is fit for use and maintain appropriate standards of hygiene for premises and equipment.

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

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

• Review availability of equipment to manage medical emergencies taking into account guidelines issued by the Resuscitation Council (UK), and the General Dental Council (GDC) standards for the dental team.
• Review the protocols and procedures for use of X-ray equipment taking into account Guidance Notes for Dental Practitioners on the Safe Use of X-ray Equipment. This relates specifically to the use of rectangular collimators.
• Review the current staffing arrangements to ensure all dental care professionals are adequately supported by a trained member of the dental team when treating patients in a dental setting taking into account the guidance issued by the General Dental Council. This relates specifically to assessing and minimising the risks when the dental hygienist works without chairside support.

Following our inspection the dental provider sent us details of the actions they were taking to make the required improvements. We will review these when we carry out a focused inspection in line with our methodology.

We spoke to three people who use the service and five members of staff.

Patients were aware of their treatment options and were satisfied that they had been given sufficient information about them. They had been involved in discussions about the risks and benefits of various treatments and were enabled to make their own choices based on them.

Patients gave positive feedback about the care provided and about the staff. Two people said the staff were "very nice." One person said "they make you feel relaxed" and one person told us that "staff are brilliant, very helpful."

Staff told us they would report any suspicion or allegation of abuse, and we found evidence that they had received training in safeguarding adults. Staff were aware of appropriate hygiene and infection control practices. Patients told us that they were satisfied with the cleanliness of the premises and equipment. One person said "it is much improved."

Patients told us the dentists had checked they were happy with the service provided at the end of their treatment. We found evidence that staff and patient surveys and several audits of the service had been carried out.