We carried out a focused inspection of Hockley Dental Laboratory & Surgery on 15 December 2017.

The inspection was led by a CQC inspector who was supported by a specialist dental adviser.

We carried out the inspection to follow up concerns we originally identified during a comprehensive inspection at this practice on 22 August 2016 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions.

At a comprehensive inspection we always ask the following five questions to get to the heart of patients’ experiences of care and treatment:

• Is it safe?
• Is it effective?
• Is it caring?
• Is it responsive to people’s needs?
• Is it well-led?

When one or more of the five questions is 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. We did not receive an action plan from Hockley Dental Laboratory & Surgery.

At the previous comprehensive inspection 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 Good Governance 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 Hockley Dental Laboratory & Surgery on our website www.cqc.org.uk.

Our findings were:

Are services well-led?

We found this practice was providing well-led care in accordance with the relevant regulations.

The provider had made sufficient improvements to put right the shortfalls and had dealt with all the regulatory breach we found at our inspection on 22 August 2016.

We carried out an announced comprehensive inspection on 22 August 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.

Background

The practice is located within a renovated residential property in Hockley, Essex and offers a range of private preventative, restorative and cosmetic dental treatments to adult patients and children.

The practice is open and offers appointments for patients between 9am and 4pm on Mondays to Fridays. The practice is closed between 1pm and 2pm for lunch each day.

The dental practice is managed by a partnership between one dentist and a dental technician. The practice employs two associate dentist, two dental nurses, one hygienist who works on Tuesdays and Thursdays, and one receptionist.

At the time of our inspection there was no registered manager. 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. Health and social care providers who are not registered as individuals are required to have a registered manager.

The practice has three treatment rooms, a waiting room and a reception area. Decontamination takes place in a dedicated decontamination room (Decontamination is the process by which dirty and contaminated instruments are bought from the treatment room, washed, inspected, sterilised and sealed in pouches ready for use again).

We left comment cards at the practice for the two weeks preceding the inspection. 24 people provided feedback about the service in this way. All of the comments made reflected very high levels of patient satisfaction with the dental care and treatment provided and the professional attitude and understanding of the dental team.

Our key findings were:

• The practice had systems in place for investigating and learning from safety incidents or accidents. Staff were aware of their responsibilities to report incidents.
• The practice was visibly clean and clutter free. However Infection control practices were not audited to test their effectiveness.
• There systems in place to help keep people safe, including safeguarding vulnerable children and adults. However some staff had not undertaken training and there was no safeguarding lead identified.
• The practice had suitable emergency medicines and staff were trained to deal with medical emergencies.
• The practice did not have an automated external defibrillator (AED) in line with the guidelines issued by the Resuscitation Council (UK), and the General Dental Council (GDC) standards for the dental team. There was no risk assessment in place to support this decision. (An AED is a portable electronic device that analyses life threatening irregularities of the heart including ventricular fibrillation and is able to deliver an electrical shock to attempt to restore a normal heart rhythm).
• Staff were recruited robustly and all of the appropriate checks were carried out when new staff were employed.
• There were ineffective systems in place to ensure that staff undertook relevant training in respect of their roles and responsibilities within the practice.
• Patients reported that they were treated with respect and that staff were polite and helpful.
• Patients were involved in making decisions about their care and treatments.
• The practice provided a flexible appointments system and could normally arrange a routine appointment within a few days or emergency appointments mostly on the same day.
• The practice had limited governance arrangements in place to monitor and assess the quality and safety of the services provided.
• Patient’s views were sought and these were used to make improvements to the service where these were identified.

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

Ensure that there are systems in place to monitor and improve the quality of services and assess and mitigate the risks to the health, safety and welfare of patients. This includes procedures to:

• Ensure an effective system is established to assess, monitor and mitigate the various risks arising from undertaking of the regulated activities.
• Ensure that the practice’s infection control procedures and protocols are suitable 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’.
• Ensure the 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.
• Ensure the training, learning and development needs of staff members are reviewed at appropriate intervals and an effective process is established for the on-going assessment and supervision of all staff employed.
• Ensure that the practice policies and procedures are kept under regular review

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

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

• 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.
• Submit an application to CQC for a relevant person to be registered as the manager for the service.

We spoke with two people who use the service. One person said that the practice was the ‘most amazing dentist’ they had been to and that the staff were ‘lovely people and very caring’. They said they had been so impressed with the service that they had introduced new people to the practice.

The other person said they were hard of hearing but everything had been explained well and the dentist had taken account of their hearing difficulty.