During our announced comprehensive inspection of this practice on 11 October 2016 we found breaches of legal requirements of to the Health and Social Care Act 2008 in relation to regulation 17- Good Governance.

We undertook this focused inspection 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 comprehensive inspection by selecting the 'all reports' link for Kenneth Ng Surgery Limited at www.cqc.org.uk

Are services Well-led?

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

Key findings

• The provider had failed to address many of the shortfalls we had identified at our previous inspection. However, immediately following this second inspection the provider sent us sufficient evidence to demonstrate that the practice was now adequately well-led.

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

We carried out an announced comprehensive inspection on 11October 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

Kenneth Ng Surgery Limited is a small, well-established practice that provides both NHS and private dentistry services to adults and children. Dr Kenneth Ng, who is the principal dentist, owns the practice. The practice has a team of two dentists and four dental nurses. There are three treatment rooms, a separate room for the decontamination of instruments, a reception area and two waiting rooms. The practice opens on Mondays to Fridays from 8.30am to 5.30pm, and on Saturdays by appointment.

The practice owner 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.

Our key findings were:

• Patients commented on the effectiveness of their treatment, the professionalism of staff and the cleanliness of the environment. They reported that it was easy to get through on the phone and that they rarely waited long having arrived for their appointment.

• The practice had good facilities and was well equipped to treat patients and meet their needs.

• Appointments were easy to book and patients could access treatment and urgent and emergency care when required.

• Staff we spoke with felt supported by the practice owner, and there were regular practice meetings involving all staff. The practice listened to its patients and staff and acted upon their feedback.

• Essential information and evidence of some dental examinations and risk assessments was missing from patient dental care records.

• The practice’s recruitment process did not ensure that all relevant checks were undertaken before new staff began their employment.

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. For example, this includes the management of significant events and patient safety alerts; the storage of dental care products; the management of substances hazardous to health, and ensuring dental care records are maintained appropriately giving due regard to guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.

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

• Review the practice’s system for the recording, investigating and reviewing incidents or significant events with a view to preventing further occurrences and ensuring that improvements are made as a result

• Review 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 giving due regard to the Ionising Radiation (Medical Exposure) Regulations (IR(ME)R) 2000.

• Review the practice's recruitment policy and procedures to ensure they are in line with Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 so that necessary employment checks are in place for all staff and the required specified information in respect of persons employed by the practice is held.

• 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 availability of medicines and 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.

When we inspected this service on 10 January 2013 we found concerns with regards to the requirements relating to workers. We found that the service did not have effective recruitment and selection processes in place. The lack of appropriate recruitment checks meant that people could not be assured of the safety and suitability of staff appointed to work in the practice. At this follow up inspection we found improvements had been made.

We spoke with two people who received treatment and observed one person during their treatment. The people we spoke with told us that they were happy with the service that they received at the service.

One person told us that the staff were, “Very good” and about the registered person, "I never had a dentist quite as good as him." When we asked about waiting times and availability of appointments one person told us, "They are usually a lot quicker than anywhere else."

We looked at treatment records and saw that people were asked about their medical health at each appointment they attended. This meant that people were safeguarded from any procedures that might impact on their medical health.

We spoke with two staff members who were able to identify different forms of abuse against vulnerable adults and children and knew who to contact if they had any concerns. This meant that people could be assured that staff were aware safeguarding procedures.

The practice had systems in place to monitor the quality of the service. Infection control procedures were followed to maintain the safety of people who used the service.

We found shortfalls in the practice's recruitment processes. This meant that people who used the service could be at risk because not all the necessary checks had been completed to ensure that staff were of good character and had the necessary skills to complete their duties.