We carried out a follow- up inspection on 19 May 2017 at Eastside Dental Practice

We had undertaken an announced follow-up inspection of this service on 14 April 2016 as part of our regulatory functions where breach of legal requirements was found.

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

We revisited Eastside Dental Practice 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 the 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 Eastside Dental Practice 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 led by a CQC inspector who had access to remoteadvice 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, staff files, policies, procedures and staff training. We also carried out a tour of the premises.

Our key findings were:

• The practice had infection control procedures which reflected published guidance.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• The practice had systems to help them manage risk.
• The practice had thorough staff recruitment procedures.
• The clinical staff provided patients’ care and treatment in line with current guidelines.
• The practice had effective leadership. Staff felt involved and supported and worked well as a team.
• The practice had thorough staff recruitment procedures.

We carried out an announced comprehensive inspection on 14 April 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.

Eastside Dental Practice is located in the London Borough of Tower Hamlets. The practice is on the first and second floor and comprises of two surgeries and a decontamination room. There is also a reception and waiting area. Toilet facilities for patients were also available.

The practice provides NHS and private dental services and treats both adults and children. The practice offers a range of dental services including routine examinations and treatment.

The staff structure of the practice comprises of two principal dentists, eight associate dentists and four dental nurses. The practice was open Mondays from 9am-8pm, Tuesdays from 9am-7.30pm and Wednesday to Saturday from 9am-6pm.

One of the principal dentists 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.

The inspection took place over one day and was carried out by a CQC inspector and a dental specialist advisor.

We received feedback from 17 patients. The feedback from the patients was positive in relation to the care they received from the practice. They were complimentary about the friendly and caring attitude of the staff.

Our key findings were:

• There were arrangements in place to deal with foreseeable emergencies
• The practice had policies and procedures in place for child protection and safeguarding adults.
• There were systems in place to reduce the risk and spread of infection. Staff had access to an automated external defibrillator (AED) and other equipment and medicines to manage medical emergencies in line with current guidance
• Patients’ needs were assessed and care was planned.
• Patients indicated that they felt they were listened to and that they received good care from a helpful and patient practice team.
• The practice had systems in place to receive alerts from relevant external organisations such as Medicines and Healthcare products Regulatory Agency (MHRA); however it did not have a system in place to share this information with staff.
• There was a complaints procedure available for patients.
• The practice had a clear management structure but there were limited governance arrangements in place for the smooth running of the practice.
• Improvements were required in the completion of dental care records
• Risks relating to the health, safety and welfare of service users and others who may be at risk which arise from the carrying on of the regulated activity had not been fully mitigated.

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

• 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 suitable governance arrangements are in place and an effective system is established to assess, monitor and mitigate the various risks arising from undertaking of the regulated activities.

• Ensure there are suitable protocols for completion of dental care records giving due regard to guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.

There were areas where the practice 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 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 practices’ current Legionella risk assessment and implement 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’.

• Review the practice's protocols for monitoring and recording the fridge temperature to ensure that dental care products are being stored in line with the manufacturer’s 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.

• Review its audit protocols to ensure X-ray and dental care record audits are undertaken accurately and where applicable learning points are documented and shared with all relevant staff.

• Review the storage of dental care records to ensure they are stored securely

People who spoke with us said that they were involved in decisions in relation to their care and treatment. People told us that they were happy with the care they received and that they were able to make choices in regards to this care.

We reviewed record cards and found that they contained information about the person’s oral health and treatment preferences as well as details of other health professionals involved in the care given.

Staff had access to training such as safeguarding vulnerable adults and children and had an awareness of the signs and symptoms of abuse and reporting methods.

Staff had access to a range of training complementary to their work. There was a system in place for appraising staff and staff meetings were being held regularly.

Audits and surveys were conducted annually to monitor the quality of services provided.