We carried an unannounced focused follow up inspection on 14 July 2017 at Dental Harmony.

We had undertaken an announced comprehensive inspection of this service on 31 January 2017 as part of our regulatory functions where breaches of legal requirements were found.

After the inspection, the practice wrote to us to say what they would do to meet the legal requirements in relation to the breaches.

We revisited Dental Harmony as part of this review and checked whether they had followed their action plan.

We reviewed the practice against one of the five questions we ask about services:

• Is it well-led?

This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection by selecting the 'all reports' link for Dental Harmony on our website at www.cqc.org.uk.

Background

This inspection was planned to check whether the practice was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The follow up inspection was carried out by a CQC inspector who had access to remote advice from a specialist advisor.

During our inspection visit, we checked that points described in the provider’s action plan had been

implemented by looking at a range of documents such as risk assessments, policies, procedures and staff training. We also spoke with staff and carried out a tour of the premises.

Our key findings were:

• Systems were in place to assess, monitor and improve the quality of the service
• The practice had systems to help them manage risk.
• Equipment was maintained and serviced in line with the manufacturer’s instructions.
• The practice had infection control procedures which reflected published guidance.
• The practice had policies and procedures to underpin the day to day management of the service and there were arrangements to ensure that these were understood and followed.

We carried out an announced comprehensive inspection on 30 January 2017 to ask the practice the following key questions; Are services safe, effective, caring, responsive and well-led?

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

Dental Harmony in Gants Hill London provides private dental treatment to patients of all ages. The provider told us that the patients visiting the practice were predominantly from the Lithuanian and Russian community.

Practice staffing consists of four associate dentists, orthodontic therapist, oral surgeon, orthodontist, two trainee dental nurses, two administrators and a practice manager.

The practice owner is the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons 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 practice is open Monday to Friday 10am to 8pm and Saturday 9am to 6pm

The practice facilities include two treatment rooms a decontamination room, reception/waiting area, and a staff room/kitchen.

15 patients provided feedback about the service. Patients who completed comment cards were very positive about the care they received from the service. Patients told us that they were happy with the treatment and advice they had received.

Our key findings were:

• Patients’ needs were assessed and care was planned in line with current guidance such as from the National Institute for Health and Care Excellence (NICE).

• The practice sought feedback from patients about the services they provided and acted on this to improve its services.
• The practice had a procedure for handling and responding to complaints, which were displayed and available to patients.
• Equipment, such as the autoclaves, fire extinguishers and compressor had all been checked for effectiveness and had been regularly serviced.
• Patients received clear explanations about their proposed treatment, costs, benefits and risks and were involved in making decisions about it.
• Patients were treated with dignity and respect and confidentiality was maintained.
• Not all clinical staff had been trained to handle medical emergencies and not all recommended medicines and life-saving equipment were readily available.
• Infection control protocols were not being followed in line with recommended national guidance.
• The practice had not ensured that all the specified information relating to persons employed at the practice was obtained and appropriately recorded.
• Governance systems were not effective. The practice had not carried out radiography audits. The practice had carried out limited risk assessments to safeguard the health and safety of staff and patients.
• Not all staff had received safeguarding children and adults training; however staff knew the processes to follow to raise any concerns. The practice had whistleblowing policies and procedure and staff were aware of these and their responsibilities to report any concerns.
• Improvements could be made to ensure dental care records were being suitably completed in line with guidance provided by the Faculty of General Dental Practice.

We identified regulations that were not being met and the provider must:

• Ensure an effective system is established to assess, monitor and mitigate the various risks arising from undertaking of the regulated activities.
• Ensure systems are in place to assess, monitor and improve the quality of the service. This could include for example undertaking regular audits of various aspects of the service and ensuring that where appropriate audits have documented learning points and the resulting improvements can be demonstrated.
• Ensure the practice's recruitment policy and procedures are suitable and the recruitment arrangements are in line with Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 to ensure necessary employment checks are in place for all staff and the required specified information in respect of persons employed by the practice is held.
• Ensure staff training and availability of medicines and equipment to manage medical emergencies giving due regard to guidelines issued by the British National Formulary, the Resuscitation Council (UK), and the General Dental Council (GDC) standards for the dental team.
• Ensure systems are put in place for the proper and safe management of medicines.
• Ensure the practice undertakes a Legionella risk assessment and implements the required actions giving due regard to guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices and The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance’

You can see full details of the regulations not being met at the end of this report.

There were areas where the provider could make improvements and should:

• Review the practice’s infection control procedures and protocols taking into account guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices and The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance’
• Review the practice’s safeguarding training ensuring it covers both children and adults and all staff are trained to an appropriate level for their role and aware of their responsibilities.
• Review the practice’s protocols for recording in the patients’ dental care records or elsewhere the reason for taking the X-ray and quality of the X-ray giving due regard to the Ionising Radiation (Medical Exposure) Regulations (IR(ME)R) 2000.
• Review the practice's protocols for completion of dental records giving due regard to guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.

Care and treatment was planned and delivered in a way that was intended to ensure patient's safety and welfare. The provider had implemented the necessary procedures to enable them to deal with emergencies effectively.

Patients were protected from the risk of infection because appropriate guidance had been followed. People were cared for in a clean, hygienic environment.

The provider had an effective system to regularly assess and monitor the quality of service that people receive. There was an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others.

People told us treatment options and procedures were clearly explained to them, and they were able to ask questions about anything they did not understand. Comments included "the treatment was explained, I asked quite a few questions and I understood" and "they explained what they were doing and gave me advice". People said they were treated with dignity and respect by all staff and their privacy and confidentiality was maintained.

People's needs were assessed and care and treatment was planned and delivered in line with their individual treatment plan. Those we spoke with said they were happy with the care and treatment they received. Comments included "they're very good" and "I will definitely return here". We found the provider did not have suitable procedures in place for dealing with emergencies.

The premises were visibly clean. People were satisfied with the cleanliness of the environment and the hygiene practices of staff. Comments included "the hygiene is spot on. I saw them wearing gloves and masks" and "yes, I am happy with the hygiene. It's very clean".

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

The quality of the service provided was not being regularly assessed and monitored. This placed people at risk of inappropriate and unsafe care and treatment.