We carried out an announced follow-up inspection at McCarthy Dental Practice on the 6 April 2018. This followed an announced comprehensive inspection on the 2 August 2017 carried out as part of our regulatory functions where breaches of legal requirements were found.

After the comprehensive inspection, the practice wrote to us to say what actions they would take to meet the legal requirements in relation to the breaches.

We revisited McCarthy Dental Practice and checked whether they had followed their action plan.

The practice had been served a requirement notice for issues relating to the key question of well led. We reviewed the practice against this key question which they were in breach of. We also reviewed the key question of safe as we had made recommendations and the provider had made improvements in this area. This report covers our findings in these two areas.

You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for McCarthy 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 led by a CQC inspector and a specialist dental 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, audits, medical emergency medicines and equipment and policies.

Our key findings were:

• Appropriate systems were in place to receive safety alerts. The alerts were stored in a central location for future reference.
• Appropriate medicines and life-saving equipment were available. Logs of checks to equipment were being maintained.

• The practice had systems to help them manage risk. Governance arrangements were in place for effective and smooth running of the practice.

We carried out this announced inspection on 16 August 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 CQC inspector who was supported by a specialist dental adviser.

We told the NHS England area team and Healthwatch that we were inspecting the practice. They did not provide any information.

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 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

McCarthy Dental Practice is in South Croydon and provides NHS treatment to patients of all ages.

There is level access for people who use wheelchairs and pushchairs although the patient toilet is not accessible. There is limited car parking in the local area but there are good transport links close by to the practice.

The dental team includes two dentists. Both dentists provide nursing and reception duties. The practice has one treatment room, a consultation room, office and decontamination room.

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 McCarthy Dental Practice was one of the principal dentists.

On the day of inspection we collected 47 CQC comment cards filled in by patients and spoke with three other patients. This information gave us a positive view of the practice.

During the inspection we spoke with both the dentists. The dentists also worked as each other’s dental nurses and provided reception cover. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open: Monday to Friday from 8.45am to 4.45pm.

Our key findings were:

• The practice was clean and well maintained.
• The practice had infection control procedures which did not fully reflect published guidance.
• Staff knew how to deal with emergencies. Medicines and life-saving equipment were available although some items were missing.
• The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• The practice had 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 was very flexible and met patients’ needs.
• Both dentists worked together for the smooth running of the practice.
• The practice had systems to deal with complaints positively and efficiently.
• The practice did not have systems to help them manage risk. Risk assessments were not being carried out and there was limited evidence of monitoring for health and safety.

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

• Ensure suitable governance arrangements are in place and an effective system is established to assess, monitor and mitigate the various risks arising from undertaking the regulated activities.
• Ensure that where audits have been conducted they have documented learning points and the resulting improvements can be demonstrated.

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

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

• 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.
• 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.

On the day of our inspection we spoke with a dentist who was one of the partners in the practice. They told us the practice was managed by them and another dentist and no other staff were employed.

On the day we visited we were unable to meet people who use the service in the practice. We asked the dentist for a list of people that have recently been to the practice and we spoke to them after our inspection visit.

All the people we spoke with told us the dentist discussed their treatment options with them. One person said “my dentist explains what I need to have done before doing anything and how much it will cost”. People told us the costs of treatment were always clearly explained to them at each visit.

All the people told us the dentists were ‘really friendly’ and ‘nice’. One person said “I had a lot of treatment over the years and they are the best. I have recommended my whole family to the practice”. People we spoke with told us they felt “safe” and “trust” the dentists.

We looked at the records of people using the service. We saw people had treatment plans which set out their treatment needs and costs.

We saw the provider undertook regular audits to monitor and review the quality and safety of the service provided.