We revisited the London City Dentists on 22 January 2016 to ask the practice the following key questions; Are services safe, effective, caring, and well-led?

We as part of a review.

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 well-led?

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

We spoke with one person who used the service. They told us, "the practice is very good. They have late appointments and are flexible with times.” A detailed medical history was taken for each person and discussed during the appointment.

The service gave people suitable information about the services available and costs of treatments.

There were effective systems in place to reduce the risk of infection. Staff were able to describe the decontamination process to us and provide evidence to show that checks were carried out on equipment used.

Staff received suitable training and were registered with their professional bodies. People told us they felt well treated by competent professionals.

We carried out an announced comprehensive inspection on 29 June 2015 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 not 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.

London City Dentists is located in the London Borough of Tower Hamlets. The premises consist of one treatment room which also houses the administrative/reception desk and a dedicated decontamination area. There are no waiting area facilities available. The practice shares the premises with a medical centre and dental patients have access to shared toilet facilities.

The practice provides private dental services and treats both adults and children. The practice offers a range of dental services including routine examinations and treatment, veneers, crowns tooth whitening and oral hygiene.

The practice predominantly caters to the needs of the working professionals based in the City of London alongside their extended families and friends.

The staff structure of the practice is comprised of one principal dentist (who is the owner), two specialist dentists (with special interests in restorative dentistry), agency dental nurses and a contracted Business Manager.

The practice is open Monday to Friday from 7:45am to 5:00pm. We carried out an announced, comprehensive inspection on 29 June 2015. The inspection took place over one day and was carried out by a CQC inspector and a dentist specialist advisor.

We received 32 CQC comment cards completed by patients. Patients who completed comment cards, were positive about the care they received from the practice. They were complimentary about the friendly and caring attitude of the staff.

Our key findings were:

• The practice had some systems in place for the management of infection control and waste disposal and dental radiography.
• Staff understood their responsibilities in terms of identifying and reporting any potential abuse.

• Patients were able to make appointments when needed.

• The patient comment cards we reviewed indicated that patients were treated with kindness and respect by staff.

• There was a lack of suitable clinical governance systems in place.

• Risks such as those arising from incomplete staff recruitment checks had not been suitably identified and mitigated.

• The practice policies and protocols related to the safe running of the service were generic and not practice specific.

• The layout of the room in which dental treatment was being provided was not suitable as the reception desk was located in the same room and in close proximity to the dental chair.

• Patient confidentiality was not suitably protected as administrative functions took place in the same room as patient dental treatment and there was lack of appropriate facilities to ensure patients could have their discussions without being overheard.

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

• Establish an effective system to assess, monitor and mitigate the risks including and not limited to those arising from incomplete staff recruitment checks.

• Ensure audits of various aspects of the service, such as radiography are undertaken at regular intervals to help improve the quality of service.
• Ensure that the premises including the layout, are suitable for the service provided.
• Ensure that discussions about care, treatment and support only take place where they cannot be overheard.

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

• Review the practice’s protocols for the receipt and dissemination of alerts and guidance such as those from the Medicines and Healthcare products Regulatory Agency (MHRA) and the National Institute for Health and Care Excellence (NICE).

• Review availability of medicines to manage medical emergencies giving due regard to guidelines issued by the British National Formulary.

• Review staff awareness of the location of the medicines to manage medical emergencies.

• Review the practice’s infection control procedures and protocols 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 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.
• Review audit methodology to ensure learning points are documented and the resulting improvements can be demonstrated.