We undertook a follow up focused inspection of Hainault Dental Practice on 20 February 2019. 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 Hainault Dental Practice on 28 November 2018 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 safe or well led care and was in breach of regulations 12 Safe care and treatment, 17 Good governance and 18 Staffing 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 Hainault Dental Practice on our website www.cqc.org.uk.

• Is it safe?

• Is it well-led?

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 areas where improvement was required.

Our findings were:

Are services safe?

We found this practice was providing safe care in accordance with the relevant regulations.

The provider had made improvements in relation to the regulatory breaches we found at our inspection on 28 November 2018.

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 28 November 2018.

Background

Hainault Dental Practice is in Ilford in the London Borough of Redbridge. The practice provides NHS and private general dental treatment to patients of all ages.

The practice is situated close to public transport bus and train services.

The dental team includes the principal dentist who owns the practice, three associate dentists, two dental hygienists, four dental nurses and one trainee dental nurse. The clinical team are supported by a practice manager and a receptionist.

The practice is owned by an individual who is the principal dentist there. 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 principal dentist, one dental hygienist, one dental nurse and the practice manager.

We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Mondays to Thursdays between 9am and 5pm.

Fridays between 9am and 1pm.

Our key findings were:

• The practice infection control procedures were in line with published guidance. Staff undertook appropriate infection prevention and control training and infection prevention and control audits were carried out to monitor infection control procedures.

• There suitable systems in place to deal with medical emergencies. The recommended life-saving equipment and medicines were available and staff had completed training in medical emergencies.

• The practice had made improvements to the systems to help them manage risk. There were arrangements to ensure that risks in relation to infection control, the use and disposal of dental sharps and the management of hazardous materials were regularly assessed and managed.

• The practice had made improvements to their safeguarding processes and staff had up to date training for safeguarding adults and children.

• Improvements had been made to the practice staff recruitment procedures and the appropriate and essential checks were carried out when employing new staff.

• Improvements had been made so that the practice dealt with complaints positively and used learning from complaints to monitor and improve services.

• Improvements had been made to the arrangements to respond to the needs of patients with disability and the requirements of the Equality Act 2010.

• There was effective leadership, and improvements had been made to the arrangements for monitoring the quality and safety of the services provided.

• The arrangements for assessing and minimising risks associated with lone working had been reviewed and improved.

• Information in relation to safety including patient safety alerts, recalls and rapid response reports issued from the Medicines and Healthcare products Regulatory Agency (MHRA) were reviewed and shared to help monitor and improve safety.

We carried out this short notice announced inspection on 28 November 2018 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We planned the inspection due to concerns we received and 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 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 not 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

Hainault Dental Practice is in Ilford in the London Borough of Redbridge. The practice provides NHS and private general dental treatment to patients of all ages.

The practice is situated close to public transport bus and train services.

The dental team includes the principal dentists who own the practice, two associate dentists, two dental hygienists, two dental nurse and one trainee dental nurses. The clinical team are supported by a practice manager and a receptionist.

The practice is owned by an individual who is the principal dentist there. 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 received feedback from two patients.

During the inspection we spoke with the principal dentist, one associate dentist, two dental nurses and the practice manager.

We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Mondays to Thursdays between 9am and 5pm.

Fridays between 9am and 1pm.

Our key findings were:

• The practice appeared clean and well maintained.
• 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 practice was providing preventive care and supporting patients to ensure better oral health.
• The appointment system met patients’ needs.
• The practice asked staff and patients for feedback about the services they provided.
• The practice infection control procedures did not fully reflect published guidance. Staff did not have appropriate infection prevention and control training and some practice procedures were not in line with current guidelines.
• There were ineffective systems in place to deal with medical emergencies. Some of the recommended life-saving equipment and medicines were not available and some medicines were not in the recommended format or stored in accordance with the manufacturer’s instructions.
• The practice had some systems to help them manage risk. Improvements were needed to ensure that risks were regularly assessed and managed. This specifically relates to the Control of Substances Hazardous to Health (COSHH) 2002 Regulations (COSHH), infection control and the use of dental sharps.
• The practice had safeguarding processes. However staff did not have up to date training for safeguarding adults and children.
• The practice had staff recruitment procedures. However these were not followed and all appropriate and essential checks were not carried out when employing new staff.
• Improvements were needed so that the practice dealt with complaints positively and used learning from complaints to monitor and improve services.
• Improvements were needed to the arrangements to respond to the needs of patients with disability and the requirements of the Equality Act 2010.
• There was ineffective leadership and a lack of clinical and managerial oversight for the day-to-day running of the service. This relates specifically to the arrangements for monitoring and supporting staff to carry out their roles and monitoring the quality and safety of the services provided.

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

• Ensure care and treatment is provided in a safe way to patients.

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

• Ensure sufficient numbers of suitably qualified, competent, skilled and experienced persons are deployed to meet the fundamental standards of care and treatment.

• Ensure specified information is available regarding each person employed and where appropriate, persons employed are registered with the relevant professional body.

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 current staffing arrangements to ensure all dental care professionals are adequately supported by a trained member of the dental team when treating patients in a dental setting considering the guidance issued by the General Dental Council.
• 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).
• Review its responsibilities to respond to the needs of patients with disability and the requirements of the Equality Act 2010.

Following our inspection the provider submitted details and documents to support the actions they were taking to address the shortcomings we identified. This demonstrated a commitment to making the required improvements.

We will check on these improvements when we next inspect the practice.

People who used this dental practice told us that they were pleased with the quality of service provided. They felt that they were treated respectfully and said that treatments were clearly explained to them.

People we spoke with said: “Staff are polite and helpful and explain what is happening. They ask about health and medication. No problems. Quite happy, I have been coming for a long time.” “If I was not happy I would just not come back. I've been coming here for years and years. I travel quite a long way because I am very happy with the service. I always get a nice welcome.” “We feel that the checks and treatment were comprehensive and detailed. They explained clearly what the issue was. We were very satisfied with the overall experience. The reception staff were very kind.”