We carried out a focused inspection on 20 January 2017 at Mr Michael T C Wong’s Dental Surgery.

We had undertaken an announced comprehensive inspection of this service on 21 October 2016 as part of our regulatory functions where a breach of legal requirements was found.

After the comprehensive inspection, the practice wrote to us to say what they would do to meet the legal requirements in relation to the breach. This report only covers our findings in relation to those requirements and we reviewed the practice against one of the five questions we ask about services: is the service well-led?

This was a desktop review and we did not revisit Mr Michael T C Wong’s Dental Surgery as part of this review. We checked whether they had followed their action plan and requested documents from the provider to confirm that they now met the legal requirements.

We found that this practice was now providing well-led care in accordance with the relevant regulations.

We carried out an announced comprehensive inspection on 21 October 2016 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

Mr Michael T C Wong’s Dental Surgery is located in the London Borough of Richmond-upon-Thames. The premises are situated in a high-street location. There is one treatment room with a decontamination area, a reception room with waiting area, an X-ray area, a staff room, and a patient toilet. These are situated on the ground and first floors of the building.

The practice provides NHS and private services to adults and children. The practice offers a range of dental services including routine examinations and treatment, veneers and crowns and bridges.

The staff structure of the practice consists of a principal dentist, a trainee dental nurse and a receptionist.

The practice opening hours are Monday to Friday from 9.00am to 5.00pm and alternate Saturdays from 9.00am to 1.00pm.

The principal dentist is registered with the Care Quality Commission (CQC) as an individual, registered person. 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 inspection took place over one day and was carried out by a CQC inspector and a dental specialist advisor.

Fifty people provided feedback about the service. Patients were positive about the care they received from the practice. They were complimentary about the friendly and caring attitude of the dental staff.

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).

• There were systems in place to reduce and minimise the risk and spread of infection. However, further improvements to infection control protocols were identified during the inspection.
• The practice had safeguarding processes in place and staff understood their responsibilities for safeguarding adults and children living in vulnerable circumstances. However, not all staff were up to date with their safeguarding training at the time of the inspection.
• Staff reported incidents and kept records of these which the practice used for shared learning.
• There were arrangements in place for managing medical emergencies. However, the practice did not have access to an Automated External Defibrillator (AED), in line with current guidance, on the day of the inspection.
• Equipment, such as the air compressor, autoclave (steriliser), fire extinguishers, and X-ray equipment had all been checked for effectiveness and had been regularly serviced.
• Patients indicated that they felt they were listened to and that they received good care from a helpful and caring practice team.
• The practice ensured staff maintained the necessary skills and competence to support the needs of patients.
• The practice had implemented clear procedures for managing comments, concerns or complaints.
• The provider had a clear vision for the practice and staff told us they were well supported by the management team.
• The practice had some governance arrangements and systems to monitor the quality and safety of the service. However, audits, such as those of X-ray and dental record keeping quality had not been carried out.

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

• Ensure suitable governance arrangements are in place and an effective system is establishedto assess, monitor and mitigate the various risks arising from undertaking of the regulated activities.
• Ensure audits of various aspects of the service, such as radiography, are undertaken at regular intervals to help improve the quality of service. The practice should also ensure that, where applicable, audits have documented learning points and the resulting improvements can be demonstrated.
• Ensure the practice’s infection control procedures and protocols are suitable 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’

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 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 its responsibilities as regards to the Control of Substance Hazardous to Health (COSHH) Regulations 2002 and, ensure all documentation is up to date and staff understand how to minimise risks associated with the use of and handling of these substances.
• Review availability of equipment to manage medical emergencies giving due regard to guidelines issued by the Resuscitation Council (UK), and the General Dental Council (GDC) standards for the dental team.
• Review the practice's recruitment policy and procedures to ensure accurate, complete and detailed records are maintained for all staff. Review its responsibilities to respond to the needs of patients with disability and the requirements of the Equality Act 2010 and ensure a Disability Discrimination Act audit is undertaken for the premises.  

People using the service told us that they were satisfied with their treatment and way it was provided. They felt treated with dignity, respect and had their privacy maintained. "My dentist always greets me as a long term acquaintance". "I have established a good relationship with the dentist and would not want to go anywhere else".

They said that the procedure for consultation and treatment was fully explained including the cost of any treatment. People were also told about any risks that might arise from treatments chosen.

They did not comment on infection prevention and control systems followed by the surgery. They did tell us they thought the surgery was kept clean, tidy and felt safe using the service.

People told us they felt there were enough efficient and competent staff available to meet their treatment and care needs. "This is a nice surgery with a friendly receptionist".

People said they were also aware of the complaints procedure.

We found that the surgery provided suitable information to people for them to make an informed decision whether they wanted to proceed with treatment.

We saw that records were kept up to date and effective infection and control systems were in use.

There were adequate numbers of suitably qualified staff to meet people's needs and an easily accessible complaints policy and procedure that was followed and reviewed. People using the service also had access to the NHS complaints system.