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 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

Apple Dental Care is in the London Borough of Hammersmith. The practice provides predominantly NHS and some private treatments to patients of all ages.

The practice is located on the ground and lower ground floor of purpose adapted premises. The layout of the building did not afford the provision of step free access or accessible toilet facilities.

The practice is situated close to public transport bus services.

The dental team includes the principal dentist who owns the practice, four associate dentists and three dental nurses.

The clinical team are supported by a practice manager and a receptionist.

The practice is owned by a partnership between the principal dentist and the practice manager 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 Apple Dental Care was the practice manager.

On the day of inspection, we received feedback from 12 patients.

During the inspection we spoke with one associate dentist, one dental nurse, the practice manager and the receptionist.

We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Mondays between 9am and 7pm,

Tuesdays to Friday between 9am and 6pm and

Saturdays between 9.40am and 1.30pm.

Our key findings were:

• The practice staff recruitment procedures were followed and all of the essential checks were carried out.
• Staff treated patients with dignity and respect and took care to protect their privacy.
• The appointment system met patients’ needs.
• The practice appeared clean and well maintained.
• The practice had arrangements to deal with complaints positively and efficiently.
• The practice asked patients for feedback about the services they provided.
• The practice was providing preventive care and supporting patients to ensure better oral health.
• The practice had infection control procedures which reflected published guidance.
• Infection control audits were not carried out in accordance with current guidelines.
• There was lack of effective arrangements for dealing with medical emergencies as some equipment was not set up ready for use and staff had not completed training updates in basic life support.
• The practice had up to date safeguarding information to assist staff on how to report concerns to the local safeguarding agencies. Improvements were needed to ensure that staff had up to date safeguarding training.
• The practice systems to help them manage risk required improvements. There was limited information available in relation to minimising risks associated with hazardous substances.
• There were ineffective arrangements in place to ensure that clinical staff completed the required continuing professional development training.
• There was ineffective leadership and a lack of clinical and managerial oversight for the day-to-day running of the service.
• The practice did not have suitable information governance arrangements.

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

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

• 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 necessary to enable them to carry out the duties.

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

• 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 the practice’s protocols for referral of patients and ensure referrals are monitored suitably.