We carried out this announced follow-up inspection on 22 November 2017. The inspection was led by a Care Quality Commission (CQC) inspector who was supported by a specialist dental adviser.

At the previous comprehensive inspection on 28 April 2017 we found the registered provider was providing safe, effective, caring and responsive care in accordance with relevant regulations. We judged the practice was not providing well-led care in accordance with regulation 17 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 G M Burr & Associates on our website www.cqc.org.uk.

The provider submitted an action plan to tell us what they would do to make improvements. We undertook this inspection on 22 November 2017 to check that they had followed their plan. We reviewed the key question of well-led.

Our findings were:

Are services well-led?

We found that this practice was providing well-led care in accordance with the relevant regulations. They demonstrated they had taken action to address the shortfalls and regulatory breach we identified when we inspected their practice on 28 April 2017.

The provider had made improvements with regard to:

• Ensuring systems were in place to assess, monitor and improve the quality of the service.
• Ensuring the practice established an effective system to assess, monitor and mitigate the various risks arising from undertaking of the regulated activities.

There was an area in which the provider could make improvements. They should:

• Review the practice's protocols for completion of dental care records taking into account guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.

We carried out this announced inspection of G M Burr & Associates on 28 April 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 Care Quality Commission 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

G M Burr & Associates is in Welling, in the London Borough of Bexley, and provides approximately 33% NHS and 67% private treatment to 5000-6000 patients of all ages.

The practice is based on the first floor of a converted house and there is no level access for people who use wheelchairs and pushchairs. There is public car parking available near the practice with spaces reserved for disabled badge holders.

The dental team includes three dentists, four dental nurses, a practice manager and a receptionist. The practice has three treatment rooms.

The practice is owned by an individual. 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 collected feedback from 49 patients. This information gave us a positive view of the practice.

During the inspection we spoke with three dentists, two dental nurses, a receptionist and the practice manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open on Mondays to Fridays from 9am to 12.30pm, and from 1.30pm to 5.30pm. It is closed on weekends and bank holidays.

Our key findings were:

• The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• The practice had thorough staff recruitment procedures.
• The clinical staff provided patients’ care and treatment in line with current guidelines.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• The appointment system met patients’ needs.
• Staff felt involved and supported and worked well as a team.
• The practice asked staff and patients for feedback about the services they provided.
• The practice dealt with complaints positively and efficiently.
• The practice had infection control procedures, though they did not always reflect published guidance.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available, though improvements were needed in relation to monitoring processes.
• The practice had systems to help them manage risk, though improvements were needed in relation to ensuring risk assessments were conducted thoroughly and by qualified professionals.
• The practice was not visibly clean or well-maintained in all areas.
• Improvements could be made to ensure that all staff received fire safety training and regular infection control training updates.

Shortly after the inspection the practice took steps to begin to address the issues we identified.

We identified regulations the provider was not meeting. They must:

• Ensure systems are in place to assess, monitor and improve the quality of the service.
• Ensure the practice establishes an effective system to assess, monitor and mitigate the various risks arising from undertaking of the regulated activities.

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

• 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, and supervision of all staff.

We visited GM Burr & Associates on 20 December 2013 and spoke with the practice manager, the owner, a dentist, two nurses and the receptionist. Everyone we spoke with told us that physical improvements had been made throughout the practice, and said that they were happy with the improvements to the premises. One person said: “it’s much easier to keep clean now and everything works very well”.

We saw that significant refurbishment work had been done, particularly to the surgery treatment rooms and the decontamination cupboard, and the provider had met the standard required.

People who used the service we spoke with told us they were happy with the service they received, and that the dentists involved them in decisions about their proposed treatment. People told us the dentists were excellent and information was provided to help them to make an informed decisions.

People told us they were always treated in a respectful manner, and the dentists and staff knew them well, and were very friendly and helpful. One person said they had been coming here for 50 years, and many of their family also used the service, and were very happy with their treatment. People said that the dentists had always asked them for an update on their health at each visit. Everyone we spoke with said they were fully informed, given choices and were very happy with the service provided.

The practice treatment rooms and staff practices were clean and hygienic. The premises were maintained in a good state of cleanliness. All of the people we spoke with said they found the practice to be clean. However some of the areas used for cleaning and storage, such as some storage drawers and an instruments cleaning room were worn.

Staff were qualified and had appropriate training and supervision and were supported by the practice to update their training. Staff said they were supported by the dentist to access training and keep up to date in their practices. People understood their rights to make complaints and there were processes in place to manage these appropriately.