We carried out a follow- up inspection of this service on 25 May 2017.

We had undertaken an announced comprehensive inspection of this service on 16 February 2017 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 K. Elias Dental Surgery on our website at www.cqc.org.uk.

We carried out an announced comprehensive inspection on 16 February 2017 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

K. Elias, Dental Surgery is located in the London Borough of Haringey and provides NHS and private dental treatment to both adults and children. The premises are on the ground floor and consist of two treatment rooms, a decontamination room and a reception area. The practice is open Monday – Friday 9:00am – 5:00pm.

The staff consists of the principal dentist, two associate dentists and three dental nurses one of whom is the practice manager.

The principal dentist is registered with the Care Quality Commission (CQC) as an individual ‘registered person’. 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 23 CQC comment cards and the NHS Friends and Family test. 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:

• Patients were involved in their care and treatment planning so they could make informed decisions.

• Equipment, such as the autoclave (steriliser) had all been checked for effectiveness and had been regularly serviced.

• Patients were treated with dignity and respect.

• Patients indicated that they found the team to be efficient, professional, caring and reassuring.
• Patients had good access to appointments, including emergency appointments, which were available on the same day.
• Training, learning and development needs of individual staff members were not reviewed at appropriate intervals and the practice did not have an effective process for the on-going assessment and supervision of all staff.
• Dental care records did not show that the practice monitored patients’ oral health, screen for gum disease or gave appropriate health promotion advice.
• Leadership structures were not clear and there were limited processes in place for dissemination of information and feedback to staff.
• Risks related to undertaking of regulated activities had not been suitably identified and mitigated.
• Systems were not in place to assess, monitor and improve the quality of the service.

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 the practice’s sharps handling procedures and protocols are in compliance with the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.
• 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’

• Ensure that a system for identifying, receiving, recording, handling and responding to complaints by patients is established.

• Ensure dental care records are maintained appropriately giving due regard to guidance provided by the Faculty of General Dental Practice (FGDP) regarding clinical examinations and record keeping.

• Ensure 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 taking into account the Ionising Radiation (Medical Exposure) Regulations (IR(ME)R) 2000.
• Ensure audits of various aspects of the service, such as infection control and radiography are undertaken at regular intervals to help improve the quality of service. The practice should also ensure that where applicable audits have documented learning points and the resulting improvements can be demonstrated
• 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 the practice establishes an effective system to assess, monitor and mitigate the various risks arising from undertaking of the regulated activities.

• 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 systems are put in place for the proper and safe management of medicines.

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

• Review its responsibilities as regards to the Control of Substances Hazardous to Health (COSHH) Regulations 2002 and, ensure all documentation is up to date and staff understand how to minimise risks associated with the use of and handling of these substances.
• 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 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 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.

People using the clinic told us that their treatment options and costs were explained to them and their privacy and dignity were respected. They were able to book appointments at times convenient to them, and were seen promptly by dental staff when they arrived at the practice. They spoke highly about the expertise of their dentists, one patient in particular noted that their dentist had ‘saved my teeth.’

The clinic environment was clean with processes in place to maintain the hygiene of treatment rooms and instruments between each patient.

Appropriate records were kept of each appointment including initial assessments and medical histories.

Appropriate pre-employment checks were carried out on staff with relevant training in place addressing medical emergencies, health and safety and infection control.

However procedures in the decontamination room could be further improved, and more detailed records should be kept regarding staff recruitment, training and supervision, and quality assurance at the clinic.