We carried out this announced follow-up inspection on 13 February 2018. The inspection was led by a Care Quality Commission (CQC) inspector who was supported by a specialist dental adviser.

At the previous comprehensive inspection on 25 July 2017 we found the registered provider was providing effective, caring and responsive care in accordance with relevant regulations. We judged the practice was not providing safe or well-led care in accordance with regulation 17 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 Kings Cross Dental Practice on our website www.cqc.org.uk.

The provider submitted an action plan to tell us what they would do to make improvements. We undertook this inspection on 13 February 2018 to check that they had followed their plan. We reviewed the key questions of safe and well-led.

Our findings were:

Are services safe?

We found that this practice was providing safe care in accordance with the relevant regulations. They demonstrated they had taken action to address the shortfalls and regulatory breach we identified when we inspected their practice on 25 July 2017.

The provider had made improvements with regard to:

• Ensuring recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed, and ensuring specified information was available regarding each person employed.

Are services well-led?

We found that this practice was providing well-led care in accordance with the relevant regulations. They demonstrated they had taken action to address the shortfalls and regulatory breach we identified when we inspected their practice on 25 July 2017.

The provider had made improvements with regard to:

• Ensuring effective systems and processes were in place to ensure good governance in accordance with the fundamental standards of care.
• Ensuring persons employed in the provision of the regulated activity received the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out their duties.

There was an area in which the provider could make improvements. They should:

• Review staff training to ensure that all staff carrying out or assisting with dental procedures carried out under conscious sedation have the appropriate training and skills to carry out the role taking into account guidelines published by The Intercollegiate Advisory Committee on Sedation in Dentistry in the document 'Standards for Conscious Sedation in the Provision of Dental Care 2015, and gain documentary evidence as to the competencies and training of people delivering conscious sedation.

We carried out this announced inspection on 25 July 2017 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. 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. The inspection was led by a Care Quality Commission (CQC) inspector who was supported by a specialist dental adviser.

To get to the heart of patients’ experiences of care and treatment, we always ask the following five questions:

• Is it safe?

• Is it effective?

• Is it caring?

• Is it responsive to people’s needs?

• 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 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

Kings Cross Dental Practice is in Kings Cross, which is in the London Borough of Camden. It provides private treatment to patients of all ages.

The practice is based on the first and second floors of a leased modified building. There are two treatment rooms, a reception area, waiting room and toilet on the first floor. Restricted car parking spaces are available near the practice.

The dental team includes five dentists, two dental nurses, two dental hygienists, a receptionist, a practice manager and a domestic staff member.

The practice is owned by an individual who is the principal dentist there. They have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run.

On the day of inspection we collected eight CQC comment cards filled in by patients. This information gave us a positive view of the practice.

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

The practice is open from 8.45am to 5.45pm Monday to Friday. It is open on occasional Saturdays according to patient demand.

The practice provided dental care services under conscious sedation. However we noted various shortcomings associated with it. We brought these to the attention of the provider who took immediate action to mitigate the risks. This included voluntary cessation of the provision of dental care using conscious sedation until necessary improvements had been made.

Our key findings were:

• The practice was clean and well maintained.
• Staff felt involved and worked well as a team.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• The appointment system met patients’ needs.
• The practice asked staff and patients for feedback about the services they provided.
• The practice dealt with complaints positively and efficiently.
• There was no protocol for reporting, documenting and sharing learning from incidents.
• There was no system in place for receiving and sharing safety alerts.
• Medicines and life-saving equipment were available, though an emergency medicine was out of date and all necessary emergency equipment was not available in line with current recommendations.
• Clinical staff provided patients’ care and treatment, though improvements were required to ensure dental care records were maintained in line with current guidelines.
• Practice staff knew their responsibilities for safeguarding adults and children, though improvements could be made to ensure appropriate safeguarding policies were available.
• The practice had not established thorough staff recruitment procedures.
• Not all staff were up to date with mandatory training.
• Suitable governance systems had not been established with regard to effective quality assurance processes, or to assess, monitor and mitigate risks.

Shortly after the inspection the provider took steps to being to address the issues we identified.

We identified regulations the provider was not meeting. They must:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
• Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out their duties.
• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed, and ensure specified information is available regarding each person employed.

Full details of the regulations the provider was not meeting are at the end of this report.

There were areas where the provider could make improvements. They should:

• Review protocols and procedures for the use of X-ray equipment, taking into account Guidance Notes for Dental Practitioners on the Safe Use of X-ray Equipment.
• Review systems to ensure safety alerts are discussed with staff, acted on and stored for future reference.
• Review the practice’s system for 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 documentation of processes, records relating to people employed, and the management of regulated activities taking into account current guidance.
• Review the practice's protocols for medicines management and ensure all medicines are stored and dispensed safely and securely.
• Review the current staffing arrangements to ensure all dental care professionals are adequately supported by a trained member of the dental team when treating patients in a dental setting taking into account the guidance issued by the General Dental Council.
• Review its responsibilities to the needs of people with a disability, including those with hearing difficulties and the requirements of the Equality Act 2010.
• Review the practice's protocols for the completion of dental care records, taking into account guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.