We carried out a follow- up inspection on 19 August 2016 at HB Dental Practice.

We had undertaken an announced comprehensive inspection of this service on 14 October 2015 as part of our regulatory functions where a 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 and we reviewed the practice against three of the five questions we ask about services: is the service safe, effective and well-led?

We revisited HB Dental practice as part of this review and checked whether they had followed their action plan and to confirm that they now met the legal requirements.

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

We carried out an announced comprehensive inspection on 14 October 2015 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

HB Dental is located in the London Borough of Bromley and provides mainly NHS and private dental services to patients. The demographics of the practice was mixed, serving patients from a range of social and ethnic backgrounds. The practice is open Monday to Fridays from 9.00am to 6.00pm, except Wednesdays when they open until 7.00pm. The practice facilities include three consultation rooms, a decontamination area and reception and waiting area. The premises are wheelchair accessible.

The staff structure comprises three dentists and four dental nurses, one receptionist and a practice manager.

The practice manager is the registered manager. At the time of our inspection the practice manager was away on extended leave. The appropriate notifications had been submitted to the CQC to report the absence. 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 dentist specialist advisor.

Thirty patients provided feedback about the service. Patients were positive about the care they received from the practice. They were complimentary about the friendly and caring attitude of the dental staff.

Our key findings were:

• There were effective processes in place to reduce and minimise the risk and spread of infection.
• There were appropriate equipment and access to emergency medicines to enable the practice to respond to medical emergencies. Staff knew where equipment was stored.
• All clinical staff were up to date with their continuing professional development.
• There was appropriate equipment for staff to undertake their duties, and equipment was maintained appropriately.
• Patients’ needs were not always assessed and care was not always planned in line with current guidance.
• 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.
• There were not appropriate systems in place to safeguard patients
• Consent was not always obtained and recorded appropriately.

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

• Ensure the practice has an effective system to assess, monitor and mitigate the risks arising from undertaking of the regulated activities.
• Ensure that appropriate governance arrangements are in place for the safe running of the service by establishing systems to monitor and assess the quality of the service
• Ensure audits of various aspects of the service are undertaken at regular intervals to help improve the quality of service. Practice should also ensure all audits have documented learning points and the resulting improvements can be demonstrated.

You can see full details of the regulations not being met at the end of this report.

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

• Review staff awareness of the requirements of the Mental Capacity Act (MCA) 2005 and Gillick competency and ensure all staff are aware of their responsibilities as it relates to their role.
• Review processes in place for ensuring staff have required knowledge and understanding of safety incidents and know how and where to report them.

• Review currentprotocols and procedures to ensure that the practice is in compliance with its legal obligations under Ionising Radiation Regulations (IRR) 1999 and Ionising Radiation (Medical Exposure) Regulation (IRMER) 2000.
• Review recruitment procedures to ensure accurate, complete and detailed records are maintained for all staff.
• Review the practice's 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.
• Review practice's safeguarding protocols and staff training and ensure all staff are aware of their responsibilities.

On this occasion, we did not speak with people using the service as part of our inspection.

At our visit we found that the provider had made improvements to ensure effective checks were undertaken before employing staff.

People who used the service we spoke with all said they were very happy and satisfied with the care. One person said they and their family had been with the surgery for many years and were always provided with good care. “The reception staff are very helpful. There is flexibility in getting appointments.” One person said, “I have never had any reason to complain”. “I would give the surgery full marks, said one person we spoke with. They said they had recently moved to the area and had joined the surgery based on a friend’s recommendation. “They are like a family here,” they said. Another person said, “I have never had a problem,” when asked about their experience.

We found that people were involved in their care and treatment which was based on an assessment of their needs. The provider had policies and procedures in place to ensure cleanliness within the practice and staff followed suitable protocols to protect people against the risks of infection. Treatment records were accurate and stored securely. However, we found that the provider did not follow suitable recruitment procedures for all staff.