We carried out this announced follow-up inspection on 30 January 2019. The inspection was led by a Care Quality Commission (CQC) inspector who was supported by a specialist dental adviser.

At the previous comprehensive inspection on 8 May 2018 we found the registered provider was providing safe, effective, caring and responsive care in accordance with relevant regulations. We judged the practice was not providing well-led care in accordance with regulation 17 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 Aspire Dental Clinic Ltd on our website www.cqc.org.uk.

A follow up inspection took place on the 15 November 2018. We judged the practice was providing effective, caring and responsive care in accordance with relevant regulations. We judged the practice was not providing safe or well-led care in accordance with regulation 17 and 19 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 Aspire Dental Clinic Ltd on our website www.cqc.org.uk.

We undertook this inspection on 30 January 2019 to check if improvements had been made. We reviewed the key questions of safe and well-led.

Our findings were:

Are services safe?

• We found that this provider was providing safe care in accordance with the relevant regulations.

Are services well-led?

We found that this provider was not providing well-led care in accordance with the relevant regulations. They demonstrated they had addressed some shortfalls we identified when we previously inspected their practice 8 May 2018; however, some areas still required improvement.

The provider had made the following improvements:

• The provider had ensured equipment for use in medical emergencies was available in sufficient quantities.
• The provider had carried out a risk assessment regarding the use of radiography equipment on the premises.
• A sharps risk assessment had been carried out
• An appropriate infection prevention and control audit had been completed.
• They had addressed a risk identified from their Disability Access Audit.

Our findings at this inspection on 30 January 2019 showed that:

• Improvements were still required to suitably identify and mitigate risks related to recruitment.

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

We carried out this announced follow-up inspection on 15 November 2018. The inspection was led by a Care Quality Commission (CQC) inspector who was supported by a specialist dental adviser.

At the previous comprehensive inspection on 9 May 2018 we found the registered provider was providing safe, effective, caring and responsive care in accordance with relevant regulations. We judged the practice was not providing well-led care in accordance with regulation 17 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 Aspire Dental Clinic Ltd on our website www.cqc.org.uk.

The provider submitted an action plan to tell us what they would do to make improvements. We undertook this inspection on 15 November 2018 to check that they had followed their plan. We reviewed the key questions of safe and well-led.

Our findings were:

Are services safe?

• We found that this provider was not providing safe care in accordance with the relevant regulations. We found their recruitment procedures were still ineffective.
• We found that this provider had not established systems and processes that operated effectively to prevent abuse of service users.

Are services well-led?

We found that this provider was still not providing well-led care in accordance with the relevant regulations. They demonstrated they had addressed some shortfalls we identified when we previously inspected their practice on 9 May 2018; however, some areas still required improvement. The provider had made the following improvements:

• They ensured a Legionella risk assessment was completed.
• There was evidence the dentists were using rubber dams for root canal treatments.
• They ensured medicines and equipment available were stored and monitored appropriately.
• They ensured medicines and equipment did not pass their use-by-date.
• They improved their processes for receiving, sharing and acting on safety alerts.
• They improved storage of clinical waste and paper records.
• They ensured staff completed key training and that these records were available.

At the time of this inspection on 15 November 2018 we found there were concerns that had not been addressed. The provider did not demonstrate that they were assessing, monitoring and mitigating risks relating to the health, safety and welfare of service users, and they did not demonstrate that they had suitably improved the quality and safety of the service. Our findings were as follows:

• The provider had not ensured equipment for use in medical emergencies was available in sufficient quantities.
• The provider had still not carried out a risk assessment regarding the use of radiography equipment on the premises.
• A sharps risk assessment and an infection prevention and control audit the provider completed were not fit for purpose. They had not addressed a risk from their Disability Access Audit.
• The provider had not sought assurances that all clinical staff had achieved a suitable level of immunity to the communicable disease Hepatitis B.

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

• Ensure patients are protected from abuse and improper treatment.
• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.
• Ensure effective systems and processes are in place to ensure good governance in accordance with the fundamental standards of care.

We carried out this announced comprehensive inspection on 9 May 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

Aspire Dental Clinic Ltd is in Tufnell Park in the London Borough of Camden. The practice provides NHS and private treatment to patients of all ages.

There is no level access for people who use wheelchairs and those with pushchairs. There is restricted parking available near the practice.

The dental team includes three dentists, a practice manager, three qualified dental nurses (one of whom also undertakes receptionist duties), and a receptionist. The practice has two treatment rooms.

The practice is owned by an organisation 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 the practice was the principal dentist.

On the day of inspection, we obtained feedback from five patients.

During the inspection we spoke with the principal dentist, the practice manager, the dental hygienist, the dental nurses and the receptionist. We checked practice policies and procedures and other records about how the service is managed.

The practice is open:

• Monday –Thursday- 9am to 5pm
• Friday - 9am to 3pm
• Saturday - 8.30am to 5pm (dental hygienist) and 2pmto 5pm (Dentist, private only)

Our key findings were:

• The practice appeared clean and well maintained.
• The practice had infection control procedures.
• The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• 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.
• Not all staff knew how to deal with emergencies requiring oxygen.
• The provider had life-saving medicines though some life-saving equipment was not available.
• Recruitment checks such as employment histories, photographic identification and Disclosure and Barring Service checks were in place.
• The practice had systems to help them assess risks, though these had not been appropriately acted on.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• There was a lack of effective systems and processes to ensure good governance.
• Some infection control procedures did not reflect current guidance.

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.
• 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 their duties.

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

• Review the availability of interpreter services for patients who do not speak or understand English as a first language.
• Review the practice's protocols for completion of dental care records considering guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping, and the security of dental care records stored away from the practice.
• Review the practice’s protocols for referral of patients and ensure all referrals are monitored suitably.
• Review the practice’s policies to ensure they are up to date.