During our unannounced inspection of this practice on 01June 2017, we found breaches of the Health and Social Care Act 2008 in relation to Regulation 12- Safe care and Treatment, and Regulation 17- Good Governance.

We undertook this focused inspection on 2 August 2017 to check that the provider now met legal requirements. This report only covers our findings in relation to these requirements. You can read the report from our previous inspection by selecting the 'all reports' link for Ivory Dental and Implant Clinic at www.cqc.org.uk

Are services Safe?

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

Are services Effective?

We found that this practice was now providing effective care in accordance with the relevant regulations

Are services Well-led?

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

Key findings

• Overall, we found that satisfactory action had been taken to address the shortfalls identified at our previous inspection and the provider was compliant with the regulations.

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

• Embed newly implemented improvements into the practice and ensure they are sustained in the long term.

• Review the protocols and procedures for use of X-ray equipment, giving due regard to guidance notes on the Safe use of X-ray Equipment.

• Review 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.

• Clarify legionella and equipment management arrangements with the dental practice based on the same site.

• Obtain safety data sheets for all dangerous products used at the practice.

We carried out this unannounced responsive inspection of Ivory Dental and Implant Clinic on 1 June 2017 under Section 60 of the Health and Social Care Act 2008, after receiving concerning information about the practice. 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. A CQC inspector, who was supported by a dental adviser, led the inspection.

To get to the heart of patients’ experiences of care and treatment, we asked the following three questions:

• Is it safe?

• Is it effective?

• 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 not providing effective 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

Ivory Dental and Implant Clinic is a small practice based in Welwyn Garden City that provides both NHS and private dentistry to patients of all ages. The dental team includes a dentist, one dental nurse, and a receptionist. The practice had been part of a partnership with Ivory Dental Clinic, until December 2016, when it separated to become its own legal entity. It continues to operate from the same premises as Ivory Dental Clinic and both practices share computer software, decontamination facilities, and a number of running costs, including utility bills. They also have a shared contract to provide NHS dental care.

Ivory Dental and Implant Clinic has two treatment rooms and is open on Tuesdays to Fridays between 9am and 5pm.

There is level access for people who use wheelchairs and those with pushchairs, ground floor treatment rooms and fully enabled toilet facilities.

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.

During the inspection we spoke with the dentist, the dental nurse and the receptionist. We looked at the practice’s policies and procedures, and other records about how the service was managed.

Our key findings were:

• Feedback we reviewed from 20 of the practice’s own comment cards indicated that patients rated the dental care they received highly. Responses indicated that patients found it easy to make an appointment, that they were rarely kept waiting having arrived for their appointment, and that treatment was explained well to them.

• The practice did not have access to an automated external defibrillator and the medical oxygen available on the premises was out of date.

• The practice’s sharps handling procedures and protocols did not comply with the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.

• The practice’s conscious sedation procedures did not follow national guidance and put patients at risk.

• Governance procedures were limited and the practice had not completed any of its own risk assessments, equipment checks or audits.

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

• Ensure effective systems and processes are established to assess and monitor the service against the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and national guidance relevant to dental practice. This includes ensuring appropriate medical emergency equipment is available, ensuring effective recruitment procedures, implementing systems for receiving and responding to patient safety alerts, ensuring staff understand how to minimise risks associated with the use of dangerous substances, managing legionella, and ensuring robust audits of the service are completed.

• Ensure the practice’s protocols for conscious sedation are appropriate giving due regard to guidelines published by the Standing Dental Advisory Committee: ‘conscious sedation in the provision of dental care 2003’.

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 ensure all staff are aware of their responsibilities under the Act as it relates to their role.

• 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.