We carried an unannounced focused follow up inspection on 22 June 2017 at Lea Bridge Road Dental Practice.

We had undertaken an unannounced comprehensive inspection of this service on 22 May 2017 as part of our regulatory functions where breaches of legal requirements were found.

In response to our findings the practice voluntarily closed for a short period so that improvements to the environment could be carried out. After the inspection, the practice wrote to us to say what they would do to meet the legal requirements in relation to the breaches.

We revisited Lea Bridge Road Dental Practice as part of this review and checked whether they had followed their action plan.

We reviewed the practice against two of the five questions we ask about services:

• Is it safe?

• Is it well-led?

This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection by selecting the 'all reports' link for Lea Bridge Road Dental Practice on our website at www.cqc.org.uk.

Background

This inspection was planned to check whether the practice was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The follow up inspection was carried out by a CQC inspector who had access to remote advice from a specialist advisor.

During our inspection visit, we checked that points described in the provider’s action plan had been

implemented by looking at a range of documents such as risk assessments, policies, procedures and staff training. We also spoke with staff and carried out a tour of the premises.

Our key findings were:

• The practice was clean and well maintained.
• The practice had systems to help them manage risk.
• Equipment was maintained and serviced in line with the manufacturer’s instructions.
• The practice had infection control procedures which reflected published guidance and these were adhered and followed by staff.
• The practice had effective leadership.
• There were management systems to ensure that staff understood and followed the practice policies and procedures.
• Systems were in place to assess, monitor and improve the quality of the service.

We carried out this unannounced inspection on 22 May 2017 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We planned the inspection to check on concerns we had received and 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 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

Lea Bridge Road Dental Surgery is in Leyton in the London Borough of Waltham Forest and provides NHS and private treatment to patients of all ages.

There is level access for people who use wheelchairs and those with pushchairs.

The dental practice is owned by two dentist partners. The partners do not work at the practice. The dental team includes four associate dentists, five dental nurses, of whom three are trainee dental nurses and one receptionist. The practice has three treatment rooms.

The practice is owned by a partnership and as a condition of registration must have a person registered with the Care Quality Commission as the registered manager. Registered managers have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run. The registered manager at Lea Bridge Road Dental Surgery was the one of the dentist partners.

During the inspection we spoke with two dentists including one of the partners, two trainee dental nurses, and the receptionist. We also spoke with two patients. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open between 9am and 5.30pm on Mondays to Fridays.

Our key findings were:

• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• The practice had thorough staff recruitment procedures.
• The clinical staff provided patients’ care and treatment in line with current guidelines.
• 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.
• We noted that various areas of the practice were not clean and were not well maintained.
• Some equipment such as the X-ray equipment was not maintained or serviced in line with the manufacturer’s instructions.
• The practice had infection control procedures which reflected published guidance. However these were not adhered to or followed by some staff.
• The practice did not have effective leadership. There was a lack of management oversight to ensure that staff understood and followed the practice policies and procedures.

• 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 establishes an effective system to assess, monitor and mitigate the various risks arising from undertaking of the regulated activities.

• Ensure systems are in place to assess, monitor and improve the quality of the service such as undertaking regular audits of various aspects of the service and ensuring that where appropriate audits have documented learning points and the resulting improvements can be demonstrated.

• Ensure systems are in place to assess the risk of, and prevent, detect and control the spread of infections, including those that are health care associated.

• Ensure that the equipment and the premises used for providing care or treatment to a service user were safe for such use and used in a safe way.

F

ull 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 and should:

• Review the practice protocol and ensure staff are aware of their responsibilities as per the Duty of candour under The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The principal dentist was made aware of our findings on the day of the inspection and they were formally notified of our concerns immediately after the inspection. They were given an opportunity to put forward an urgent action plan with remedial timeframes, as to how the risks could be mitigated.

The provider responded appropriately within the required time frame to inform us of the urgent actions they had undertaken to mitigate the risks.

These included voluntarily closing the dental practice to make the necessary improvements.

The provider has submitted regular updates and assurances that the remedial work in relation to ensuring safety of the premises and equipment was being carried out.