We carried out an announced follow up inspection at Dentart on 08 March 2017.

We had undertaken an announced comprehensive inspection of this service on 13 June 2016 as part of our regulatory functions where a breach of legal requirements was found. This report only covers our findings in relation to those requirements and we reviewed the practice against Three of the five questions we ask about services: is the service safe, effective and well-led?

We revisited Dentart as part of this review and checked whether they had followed their action plan and to confirm that they now met the legal requirements.

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

However, there were areas where the provider could make improvements and should:

• 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.

We carried out an announced comprehensive inspection on 13 June 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 not providing safe care in accordance with the relevant regulations.

Are services effective?

We found that this practice was not 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

‏ Dentart is located in the London Borough of Hammersmith and provides private dental services.

The staff structure of the practice comprises of three dentists two nurses, two receptionist and practice manger.

The practice was open 10.00-6.00 pm Monday to Saturday.

Facilities within the practice include one treatment rooms, a dedicated decontamination room and a waiting area.

The practice manager was 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.

Before the inspection we sent Care Quality Commission (CQC) comment cards to the practice for patients to complete to tell us about their experience of the practice. We received comment cards from 16 patients. The feedback we received for patients gave a positive view of the services the practice provides. All of the patients commented that the quality of care was good.

We carried out an announced comprehensive inspection on 13 June 2016 as part of our planned inspection of all dental practices. The inspection took place over one day and was carried out by a lead inspector and a dental specialist adviser.

Our key findings were:

• There were effective processes in place to reduce and minimise the risk and spread of infection.
• There was lack of appropriate systems in place to safeguard patients.
• The practice did not have arrangements in place to ensure the safety of the equipment.
• Patients told us that staff were caring and treated them with dignity and respect.
• There were processes in place for patients to give their comments and feedback about the service including making complaints and compliments.
• There was a lack of an effective system to assess, monitor and improve the quality and safety of the services provided.
• Governance arrangements in place were not effective to facilitate the smooth running of the service and there was no evidence of audits being used for continuous improvements.

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

• Ensure that all staff had undergone relevant training, to an appropriate level, in the safeguarding of children and vulnerable adults.
• Ensure staff training to manage medical emergencies taking into account guidelines issued by the British National Formulary, the Resuscitation Council (UK), and the General Dental Council (GDC) standards for the dental team.

• 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 are up to date with their mandatory training and their Continuing Professional Development (CPD)
• Ensure systems are in place to assess, monitor and improve the quality of the service such as 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.

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

• Review the practice’s system for the recording, investigating and reviewing incidents or significant events with a view to preventing further occurrences and, ensuring that improvements are made as a result.

• Review it’s 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 the current legionella risk assessment and implement the required actions including the monitoring and recording of water temperatures, 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 staff awareness of the requirements of the Mental Capacity Act (MCA) 2005 and ensure all staff are aware of their responsibilities under the Act as it relates to their role.