We undertook a follow up inspection of Chigwell Smile on 7 February 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 who was supported by a specialist dental adviser.

We undertook a comprehensive inspection of Chigwell Smile on 28 June 2018 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. As a result of that inspection, we found the registered provider was not providing well led care and was in breach of 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 Chigwell Smile on our website www.cqc.org.uk.

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 breach we found at our inspection on 28 June 2018.

Background

Chigwell Smile is in Chigwell, Essex and provides NHS and private treatment to adults and children.

There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces are available near the practice.

The dental team includes two dentists, three dental nurses, one dental hygienist and a receptionist. The practice has three treatment rooms.

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 Chigwell Smile is the principal dentist.

During the inspection we spoke with two dentists, one dental nurse and one receptionist. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open: Monday to Thursday from 8am to 1pm and from 2pm to 5.30pm. Friday from 8am to 1pm and from 2pm to 5pm.

Our key findings were:

• There were effective systems and processes in place to ensure good governance in accordance with the fundamental standards of care.
• Staff had undertaken training on the requirements of the Mental Capacity Act 2005 and were aware of their responsibilities under the Act and how it related to their role. In addition, staff were aware of Gillick competency and their responsibilities in relation to this.
• Staff had a clear awareness of the need for the practice to establish parental responsibility when seeking consent for children and young people.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• Systems were in place to ensure X-ray and decontamination equipment was maintained in line with manufacturers recommendations’.
• Legionella risk assessments were undertaken and any recommended actions completed.

We carried out this announced inspection on 28 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 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

Chigwell Smile is in Chigwell, Essex and provides NHS and private treatment to adults and children.

There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces are available near the practice.

The dental team includes two dentists, three dental nurses, one dental hygienist and a receptionist. The practice has three treatment rooms.

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 Chigwell Smile is the principal dentist.

On the day of inspection we collected 35 CQC comment cards filled in by patients and spoke with two other patients.

During the inspection we spoke with one dentist, one dental nurse and one receptionist. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open: Monday to Thursday from 8am to 1pm and from 2pm to 5.30pm. Friday from 8am to 1pm and from 2pm to 5pm.

Our key findings were:

• We received positive comments from patients about the dental care they received and the staff who delivered it.
• The practice appeared clean and well maintained.
• The practice staff had infection control procedures which reflected published guidance. The practice carried out infection prevention and control audits, but not as regularly as recommended by guidance.
• The practice staff had suitable safeguarding processes and staff knew their responsibilities for safeguarding 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 staff dealt with complaints positively and efficiently.

• There was no system in place to ensure that untoward events were analysed and used as a tool to prevent their reoccurrence.

• The provider did not have all emergency medicines or equipment in line with the British National Formulary (BNF) guidance for medical emergencies in dental practice.

• Risk assessment to identify potential hazards and audit to improve the service were limited.

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.

Full details of the regulation/s the provider was/is not meeting are at the end of this report.

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

• Review the practice’s protocols for the use of rubber dam for root canal treatment taking into account guidelines issued by the British Endodontic Society.
• Review staff awareness of Gillick competency and ensure all staff are aware of their responsibilities in relation to this.
• Review the practice's policies and procedures for obtaining patient consent to care and treatment to ensure they are in compliance with legislation, take into account relevant guidance, and staff follow them.

• Introduce protocols regarding the prescribing of antibiotic medicines and review the practice's protocols for completion of dental care records, taking into account the guidance provided by the Faculty of General Dental Practice.