We carried out this announced inspection on 27 November 2018 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

Maxident – Linden Grove is in the London Borough of Southwark and provides NHS and private treatment to patients of all ages.

There is level access to the reception area, waiting area and surgery for people who use wheelchairs, and those with pushchairs.

The dental clinical team includes a principal dentist, two associate dentists, three qualified dental nurses (one of whom was on leave at the time of the inspection) and a trainee dental nurse. The clinical team is supported by a practice manager who also undertakes receptionist duties. The practice has three treatment rooms, one of which was not in use at the time of the inspection.

The practice is owned by an organisation, 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. At the time of the inspection the practice did not have a registered manager in post.

On the day of inspection, we obtained feedback from four patients.

During the inspection we spoke with two dentists, a dental nurse, and the practice manager. We checked practice policies and procedures and other records about how the service is managed.

The practice is open from 9am to 5.30pm Monday to Friday.

Our key findings were:

• The practice appeared clean.
• Staff knew their responsibilities for safeguarding adults and children.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• The practice was providing preventive care and supporting patients to ensure better oral health.
• The appointment system met patients’ needs.
• Staff felt involved and supported and worked well as a team.
• The practice had a complaints procedure in place.
• The practice had suitable information governance arrangements.
• The provider had medicines on site, though some recommended emergency equipment was not available. A senior member of staff was not able to demonstrate to us the use of emergency equipment.
• The provider had not established effective procedures for monitoring and managing stock and equipment.
• The practice’s infection control procedures did not reflect current guidance in some areas.
• The practice had not established thorough procedures for staff recruitment, appraisal and training.
• Rubber dam was not consistently used for root canal treatments; this had not been risk assessed or suitably recorded.
• Effective processes had not been established for the use of radiography on the premises.
• The practice had ineffective systems to help them assess, monitor and manage risks relating to undertaking of the regulated activities. The practice did not demonstrate effective leadership at the time of this inspection, though they showed willingness to address the concerns we identified during the inspection.

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

• Ensure care and treatment is provided in a safe way to patients
• 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.

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

• Review the practice's protocols for completion of dental care records considering guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.
• Review the practice’s protocols for the use of rubber dam for root canal treatment taking into account guidelines issued by the British Endodontic Society.
• Review the processes and systems in place for seeking and learning from patient feedback with a view to monitoring and improving the quality of the service.
• Review the availability of interpreter services for patients who cannot speak or understand English.
• Review staff awareness, and understanding of their responsibilities relating to, and external reporting and notification systems.

At our inspection in January 2013 we found that some staff training was out of date. At this inspection we found that this had been addressed and all staff had recently completed training on basic life support, safeguarding of vulnerable adults and children, and decontamination and infection control.

An induction process was in place to support new staff and all staff had received an annual appraisal.

We spoke to a parent who had brought a child for an appointment. She said that treatment was always fully explained and staff were "very kind and helpful". Appointments were available at suitable times in the day and there wasn't very long to wait.

Another person we spoke to had been coming to the practice for 10 years. He confirmed that staff wore gloves, masks and protective glasses, the surgeries were clean and the appointments were usually on time. If they were running late he would be informed. His treatment and available choices were fully explained and he confirmed he was very happy with the practice.