We carried out a follow-up inspection of this service on 12 October 2016.

We had undertaken an announced comprehensive inspection of this service on 28 June 2016 as part of our regulatory functions where 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.

We reviewed the practice against three of the five questions we ask about services: is the service safe, effective and well-led?

We revisited the surgery as part of this review and checked whether they had followed their action plan.

You can read the report from our last comprehensive inspection by selecting the 'all reports' link for GN Rashid on our website at www.cqc.org.uk.

We carried out an announced comprehensive inspection on 28 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

GN Rashid is located in the London Borough of Brent and provides mainly NHS dental treatment to both adults and children. The premises are on the first floor, above retail premises and consist of one treatment rooms, a reception area and a decontamination room. The practice is open Monday to Friday 9:30am – 6:00pm.

The staff consists of one principal dentist and a trainee dental nurse who is also the receptionist.

The principal dentist is registered with the Care Quality Commission (CQC) as an individual. 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.

We reviewed 17 CQC comment cards and the NHS Friends and Family test comment cards. Patients were positive about the service. They were complimentary about the friendly and caring attitude of the staff.

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

Our key findings were:

• There was lack of appropriate equipment and access to emergency drugs to enable the practice to respond to medical emergencies.
• Patients had good access to appointments including emergency appointments.
• We observed staff to be caring, friendly, reassuring and welcoming to patients.
• Patients indicated that they found the team to be efficient, professional, caring and reassuring.

• There was a lack of effective arrangements in place to meet the Control of Substances Hazardous to Health 2002 (COSHH) Regulations.
• The practice infection control procedures required improvement in line with current national guidance.
• Staff did not receive appropriate support and appraisal as is necessary to enable them to carry out their duties.
• There was a lack of an effective system to assess, monitor and mitigate the risks relating to the health, safety and welfare of patients, staff and visitors.
• 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.

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

• 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’.
• Ensure that the practice has appropriate procedures and implements relevant processes to safeguard people.
• 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 that the practice is in compliance with its legal obligations under Ionising Radiation Regulations (IRR) 99 and Ionising Radiation (Medical Exposure) Regulation (IRMER) 2000.
• Ensure the training, learning and development needs of individual staff members are reviewed at appropriate intervals and an effective process is established for the on-going assessment and supervision of all staff.
• Ensure audits of various aspects of the service, such as radiography, infection control and dental care records are undertaken at regular intervals to help improve the quality of service. The practice should also check that where applicable audits have documented learning points and the resulting improvements can be demonstrated.
• Ensure the practice establishes an effective system to assess, monitor and mitigate the various risks arising from undertaking of the regulated activities.
• Ensure the practice undertakes a Legionella risk assessment and implements 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.

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

• 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 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 protocols for the use of rubber dam for root canal treatment giving due regard to guidelines issued by the British Endodontic Society.

• Review the practice’s protocols for recording in the patients’ dental care records or elsewhere the reason for taking the X-ray and quality of the X-ray giving due regard to the Ionising Radiation (Medical Exposure) Regulations (IRMER) 2000.

• Review the storage of records related to people employed and the management of regulated activities giving due regard to current legislation and guidance.

• Review staff awareness of Gillick competency and ensure all staff are aware of their responsibilities.

• Review the practice’s waste handling policy and procedure to ensure waste is segregated and disposed of in accordance with relevant regulations giving due regard to guidance issued in the Health Technical Memorandum 07-01 (HTM 07-01).
• Review the practice protocols and adopt an individual risk based approach to patient recalls giving due regard to National Institute for Health and Care Excellence (NICE) guidelines.

• Review the practice’s protocols and procedures for promoting the maintenance of good oral health giving due regard to guidelines issued by the Department of Health publication ‘Delivering better oral health: an evidence-based toolkit for prevention’.

• 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 found a clean well maintained and well run dental practice situated above shops, just off a main High Street.

Patient's feedback, as well as discussions and observations with patients confirm they were happy with the service provided. They felt that they were given enough information about their treatment options as well as the fee scales and had no hesitation in asking any question in relation to their treatment or cost.

Our inspection found the dentist to be friendly and accommodating. We can report that patients were treated with respect and dignity as well as maintaining privacy.

Consultations took place within a private surgery, where privacy and confidentiality were ensured.

We observed that patients completed a medical history at their first visit and prior to any consultation or treatment with the dentist. We also observed medical histories being updated for several patients. Consent forms were signed before any treatment was commenced.

Paper files were stored within the confines of the practice and held securely.