We carried out a follow- up inspection on 16 February 2017at Marble Arch Dental Centre

We had undertaken an unannounced comprehensive inspection of this service on 25 August 2016 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.

We revisited Marble Arch Dental Centre as part of this review and checked whether they had followed their action plan.

We reviewed the practice against one of the five questions we ask about services: is the service 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 Marble Arch Dental Centre on our website at www.cqc.org.uk.

We carried out an announced comprehensive inspection on 25 August 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

Marble Arch Dental Centre provides NHS and private dental treatment to patients of all ages. The services provided include preventative advice and treatment and routine restorative dental care.

The practice staffing consists of three principal dentists, 11 associate dentists, six qualified dental nurses, six trainee dental nurses, two hygienists and eight receptionist/administration staff.

One of the principal dentists is the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. 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.

The practice consists of six treatment rooms, a decontamination room, two waiting areas for patients and two reception areas and a staff room

The practice opening hours are Monday to Friday 8am to 8pm and Saturday 10am to 4pm.

22 patients provided feedback about the service. Patients we spoke with and those who completed comment cards were very positive about the care they received and about the service. Patients told us that they were happy with the dental treatment and advice they had received.

Our key findings were:

• Patients’ care and treatment was planned and delivered in line with current legislation and evidence based guidelines such as from the National Institute for Health and Care Excellence (NICE).
• There were sufficient numbers of suitably qualified staff to meet the needs of patients.
• Patients were treated with dignity and respect and patient confidentiality was maintained.

• The practice had a procedure for handling and responding to complaints.

• The practice had whistleblowing policies and procedure and staff were aware of these and their responsibilities to report any concerns.

• The practice didn’t have arrangements for receiving and responding to patient safety alerts issued from relevant external agencies.
• The practice had not ensured that appropriate equipment in line with Resuscitation Council (UK) guidance, was available to respond to a medical emergency.
• Staff had not undertaken training in key areas such as safeguarding children and adults, infection control and basic life support. There was lack of oversight of staff’s continuing professional development (CPD) activity and it was not being suitably monitored.

• Infection control protocols were not being followed in line with recommended national guidance.

• Systems were not in place to ensure that equipment including all of the autoclaves, compressors, washer disinfector and X-ray units were well maintained;

• Governance systems were not effective. The practice had not carried out audits in key areas, such as radiography and record keeping. The practice had carried out limited risk assessments to ensure the health and safety of staff and patients.

• The practice had not ensured that all the specified information relating to persons employed at the practice was obtained and appropriately recorded.

• Dental care records were not being suitably completed in line with guidance provided by the Faculty of General Dental Practice.

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

• Ensure an effective system is established to assess, monitor and mitigate the various risks arising from undertaking of the regulated activities.
• Ensure the practice's recruitment policy and procedures are suitable and the recruitment arrangements are in line with Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 to ensure necessary employment checks are in place for all staff and the required specified information in respect of persons employed by the practice is held.

• Ensure systems are in place to assess, monitor and improve the quality of the service.
• Ensure audits of various aspects of the service, such as radiography, infection control and dental care records are undertaken at regular intervals to help improve the quality of service. The practice should also ensure that where appropriate audits have documented learning points and the resulting improvements can be demonstrated.

You can see full details of the regulations not being met at the end of this report.

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

• Review staff training 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.

• Review the practice’s safeguarding policy and staff training (delete as appropriate); ensuring it covers both children and adults and all staff are trained to an appropriate level for their role and aware of their responsibilities.
• Review the training, learning and development needs of individual staff members and have an effective process established for the on-going assessment and supervision of all staff.
• Review the practice's protocols for completion of dental care records giving due regard to guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.
• Review stocks of medicines and equipment and the system for identifying, disposing and replenishing of out-of-date stock.
• 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.

We spoke with five people who use the service who were satisfied with the care and treatment they received. People told us that they were treated respectfully by staff.

People were given sufficient information about their care and treatment, including information about their treatment plans and options. We saw that each person had a dental treatment plan and that the dentists took a medical history on their first appointment, which was then checked on subsequent appointments.

There were emergency procedures in place and staff knew what to do in the case of an emergency.

There were effective systems in place to reduce the risk of infection. Staff showed us the decontamination procedures they completed daily and demonstrated their understanding of infection control.

The service responded appropriately to concerns and complaints.

We carried out an announced comprehensive inspection of the GP service at this location on 27 October and 14 November 2016 to ask the service the following key questions; Are services safe, effective, caring, responsive and well-led?

Our findings were:

Are services safe?

We found that this service was not providing safe care in accordance with the relevant regulations.

Are services effective?

We found that this service was providing effective care in accordance with the relevant regulations.

Are services caring?

We found that this service was providing caring services in accordance with the relevant regulations.

Are services responsive?

We found that this service was providing responsive care in accordance with the relevant regulations.

Are services well-led?

We found that this service was not providing well-led care in accordance with the relevant regulations.

Background

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the service was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008. We have not inspected the GP service before.

Marble Arch Dental Centre provides NHS and private dental treatment to patients of all ages. It also provides an appointment based private GP service and an opticians.

The practice staffing consists of three principal dentists, 11 associate dentists, six qualified dental nurses, six trainee dental nurses, two hygienists and eight receptionist/administration staff. Two doctors provide the GP service.

One of the principal dentists is the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. 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, including the GP service.

The GP service is provided from one consultation room. There is a main reception for both the dental and GP services, and a waiting area. The GP service is provided predominantly on Saturdays, and only by appointment.

During this visit we were unable to obtain the views of patients as none were available.

Our key findings were:

• The GPs were suitably qualified to meet the needs of patients.
• The consultation room used for the GP service was visibly clean and tidy.
• The service was accessible to patients who required non-emergency treatment and who were willing to pay private consultation fees.
• The registered provider had not ensured that all the specified information relating to persons employed at the service was obtained and appropriately recorded.
• The service had emergency equipment however it was not being regularly checked to ensure it functioned correctly. Emergency medicines were in place but not all were appropriately stored.
• Refrigerator temperatures were not being checked daily or recorded. We noted on our second visit that records of checks were now being kept and a second thermometer had been purchased.
• Patient records were incomplete in many cases, lacking adequate contact information.
• Staff employed in the dental and optician service would act as chaperones when required but not all had undergone a disclosure and barring service check. Both GPs told us that they had not, to date, seen a patient who had requested a chaperone.
• Governance systems were not effective. There were no systems to assess, monitor and improve the quality of the GP service or to assess, monitor and mitigate the various risks arising from undertaking of the regulated activities.

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

• Ensure equipment is regularly checked and calibrated where necessary.
• Ensure emergency medicines are appropriately stored.
• Ensure an effective system is established to assess, monitor and mitigate the various risks arising from undertaking of the regulated activities.
• Ensure the practice's recruitment policy and procedures are suitable and the recruitment arrangements are in line with Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
• Ensure they maintain accurate, complete and contemporaneous records in respect of each service user.
• Ensure systems are in place to assess, monitor and improve the quality of the service.
• Ensure all staff who chaperone have undergone a disclosure and barring service check.

You can see full details of the regulations not being met at the end of this report.

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

• Review and update the practice’s safeguarding policy.
• Review the list of emergency medicines and amend stocked medicines where appropriate.
• Remove the unused medicines kept in the GP consultation room.