We undertook a follow up focused inspection of Dental Design Studio Walthamstow on 10 May 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 Dental Design Studio Walthamstow on 22 November 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 safe, effective or well led care and was in breach of regulations 17 – Good governance, 18 - Staffing and 19 - Fit and proper persons employed 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 Dental Design Studio Walthamstow on our website www.cqc.org.uk.

• Is it safe?

• Is it effective

• Is it well-led?

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 areas where improvement was required.

Our findings were:

Are services safe?

We found that this practice was providing safe care in accordance with the relevant regulations. The provider had made improvements in relation to the regulatory breaches we found at our inspection on 22 November 2018.

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 22 November 2018.

Background

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

The practice is situated close to public transport bus and train services. The dental team includes two partners who own the practice, seven associate dentists, two dental hygienists, one dental nurse and four trainee dental nurses. The clinical team are supported by a practice manager and a receptionist.

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 Dental Design Studio Walthamstow was the one of the partners.

During the inspection we spoke with the dental partners and one dental nurse.

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

The practice is open:

Mondays to Fridays between 8am and 5pm

Alternate Saturdays between 8.45am and 1pm.

Our key findings were:

• There were systems to ensure that staff had suitable immunity against vaccine preventable infectious diseases. The practice’s sharps procedures were in compliance with the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.

• There were arrangements to monitor and improve quality in relation to dental radiography though a system of audits.

• There were suitable arrangements to deal with medical emergencies. All of the recommended life-saving equipment and medicines were available and staff had undertaken training in basic life support.

• The practice had systems to help them manage risk.

• The practice had suitable staff recruitment procedures which they followed.

• There were processes in place to ensure the on-going supervision and appraisal for staff.

• There were systems in place to ensure that staff undertook training and periodic training updates in areas relevant to their roles including training in safeguarding children and vulnerable adults and training in infection control.

• There were systems to ensure that dental care products and medicines requiring refrigeration were stored in line with the manufacturer’s guidance.

• There were arrangements to minimise risks associated with the use and handling of hazardous substances, taking into account the Control of Substances Hazardous to Health (COSHH) Regulations 2002.

• Information in relation to safety including patient safety alerts, recalls and rapid response reports issued from the Medicines and Healthcare products Regulatory Agency (MHRA) were reviewed and shared to help monitor and improve safety.

• There were systems to ensure that urgent and routine referrals were monitored suitably.

• Improvements had been made to the arrangements to respond to the needs of patients with disability and the requirements of the Equality Act 2010.

We carried out this announced inspection on 22 November 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 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

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

The practice is situated close to public transport bus and train services.

The dental team includes the two partners who own the practice, eight associate dentists, two dental hygienists, one dental nurse and two trainee dental nurses. The clinical team are supported by a practice manager and a receptionist.

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 Dental Design Studio Walthamstow was the one of the partners.

On the day of inspection we received feedback from three patients.

During the inspection we spoke with one of the partners, three associate dentists, one dental nurse and the practice manager. We also spoke with a practice manager from one of the providers’ other dental practices who was providing support to this practice.

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

The practice is open:

Mondays to Fridays between 8am and 5pm

Alternate Saturdays between 8.45am and 1pm.

Our key findings were:

• The practice appeared clean and well maintained.
• 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 asked staff and patients for feedback about the services they provided.
• The practice dealt with complaints positively and efficiently.
• The practice infection control procedures did not fully reflect published guidance. Staff did not have appropriate infection prevention and control training and there were ineffective systems to ensure that staff had suitable immunity against vaccine preventable infectious diseases.
• Improvements were needed to the arrangements to deal with medical emergencies. Some of the recommended life-saving equipment was not available and some medicines were not in the recommended format or stored in accordance with the manufacturer’s instructions. These items were made available shortly after our inspection.

• The practice had some systems to help them manage risk. Improvements were needed to ensure that risks were regularly assessed and managed. This specifically relates to Control of Substances Hazardous to Health (COSHH) 2002 Regulations (COSHH), fire safety and the use of dental sharps.
• The practice had safeguarding processes. However staff did not have up to date training for safeguarding adults and children.
• The practice had staff recruitment procedures. However these were not followed and all appropriate checks were not carried out when employing new staff.
• There was ineffective leadership and a lack of clinical and managerial oversight for the day-to-day running of the service. This relates specifically to the arrangements for monitoring and supporting staff to carry out their roles and monitoring the quality and safety of the services provided.

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 sufficient numbers of suitably qualified, competent, skilled and experienced persons are deployed to meet the fundamental standards of care and treatment.
• Ensure specified information is available regarding each person employed and where appropriate, persons employed are registered with the relevant professional body.

Full details of the regulations the provider was not meeting are at the end of this report.

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

• Review the storage of dental care products and medicines requiring refrigeration to ensure they are stored in line with the manufacturer’s guidance and the fridge temperature is monitored and recorded.
• 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 considering the guidance issued by the General Dental Council.
• 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 security of prescription pads in the practice and ensure there are systems in place to track and monitor their use.
• Review the practice’s protocols for referral of patients and ensure urgent referrals are monitored suitably.
• Review the practice’s protocols for the use of closed circuit television cameras (CCTV) taking into account guidelines published by the Information Commissioner's Office (ICO).