We undertook a follow up focused inspection of Dr Philip Stemmer on 11 July 2018. 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 Dr Philip Stemmer on 22 November 2017 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 well led care in accordance with the relevant regulations 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 Dr Philip Stemmer on our website www.cqc.org.uk.

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 area where improvement was required.

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 breaches we found at our inspection on 22 November 2018.

Background

Dr Philip Stemmer is located in Westminster and provides private treatment to patients of all ages.

The dental team includes a dentist and a dental nurse.

The practice is owned by an individual who is the principal dentist. They have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run.

During the inspection we spoke with the dentist and the dental nurse. We also spoke with a compliance consultant that the provider had employed. We looked at practice policies and procedures and other records about how the service is managed.

Our key findings were:

• The practice had systems and processes to ensure good governance in accordance with the fundamental standards of care, including policies, procedures, risk assessments and quality assurance processes.
• The practice received and responded to patient safety alerts, recalls and rapid response reports issued from the Medicines and Healthcare Products Regulatory Agency (MHRA).
• The practice had a system in place for investigating and reviewing incidents or significant events with a view to preventing further occurrences and ensuring that improvements are made as a result.
• The practice had safeguarding policies that covered both adult and children.
• The practice had some understanding of the requirements of the Mental Capacity Act (MCA) 2005 but further improvements were still required.
• The practice had policies and procedures in place for obtaining patient consent to care and treatment.
• The practice had complaints policies and procedure for identifying, receiving, recording, handling and responding to complaints by service users. Staff were clear who were responsible for dealing with complaints.
• The practice had a recruitment policy and had undertaken essential recruitment checks for staff.

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

• Review the practice’s audit protocols to ensure audits of various aspects of the service, such as radiography have documented learning points that are shared with all relevant staff and the resulting improvements can be demonstrated.

We carried out this unannounced inspection on 22 November 2017 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

Dr Philip Stemmer is located in Westminster and provides private treatment to patients of all ages.

There is access for people who use wheelchairs and those with pushchairs via a movable ramp.

The dental team includes two dentists, two dental nurses and a practice manager.

The practice is owned by an individual who is the principal dentist. They have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run.

On the day of inspection we spoke with two patients. This information gave us a positive view of the practice.

During the inspection we spoke with both dentists, both dental nurses and the practice manager. We also spoke with a consultant that the principal had employed. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open Monday to Thursday 9.00am – 5.00pm and Fridays 9.00am – 3.00pm

Our key findings were:

• The practice was clean and well maintained.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• The practice had some systems in place to help them manage risk but improvements were required to this system
• The practice had some systems in place for safeguarding adults and children but improvements were required in regards to the practice safeguarding policy and safeguarding training for staff.
• The practice had carried some checks when recruiting staff. No records were available for a recently recruited staff member.
• The clinical staff provided patients care and treatment that was based on the patients’ needs.
• Staff treated patients with dignity and respect.
• The appointment system met patients’ needs.
• The practice lacked effective systems and processes to ensure good governance.
• The practice did not have effective leadership. Some staff felt involved and supported to work at the practice, others told us they did not.
• The practice told us they asked patients for feedback about the services they provided but were not able to confirm how this information was used to improve the service.
• The practice had some systems in place to deal with complaints, though improvements were required with regards to staff understanding of the local protocols.

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 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 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 practice’s system for 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 practice's safeguarding policy and staff training and ensure the policy refers to both adult and children.

• 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.

• Review current policies and procedures for obtaining patient consent to care and treatment and ensure they reflect current legislation and guidance, and that staff follow them at all times.

• Review its complaint handling procedures and establish an accessible system for identifying, receiving, recording, handling and responding to complaints by service users.

• Review the training, learning and development needs of individual staff members at appropriate intervals and ensure an effective process is established for the on-going assessment, supervision and appraisal of all staff

• Review the practice's recruitment policy and procedures to ensure accurate, complete and detailed records are maintained for all staff.

We spoke with three people, all of whom had used the practice for some years and who said that they were given adequate information about options so that they could make decisions about their treatment. One said their dentist “put them at ease” and they were “very happy with the practice”. Another said staff were ”welcoming and helpful”. One person said that the dentist was very good with children. They all said the practice was clean.

Each person was assessed for their suitability prior to any treatment and was offered choices about treatment and given information about what the treatment involved and the likely costs.

There were suitable processes for staff training and professional development. All staff had received training in infection control and managing medical emergencies.

There were effective systems in place to reduce the risk and spread of infection. A recent infection control audit had been undertaken and staff were observed wearing personal protective equipment, such as gloves and masks. Decontamination of instruments was undertaken safely.

The provider had systems to review and monitor the quality and safety of the service provided. Staff discussed the overall running of the service and had clearly defined roles and responsibilities. Risk assessments had been undertaken.