We carried out this unannounced inspection on 07 March 2019 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions.

We planned the inspection in response to concerns we received. We checked 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.

We asked the following questions:

• Is it safe?

• Is it well-led?

We focused on the practice’s infection prevention and control processes and their management of medicines and materials.

Our findings were:

Are services safe?

We found that this practice was not providing safe 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

Medidenta Medical Practice is in Welling, in the Greater London Borough of Bexley. The practice provides private treatment to adults and children.

The dental team includes a dental hygienist and therapist, three dentists, a qualified dental nurse, a trainee dental nurse, and a compliance adviser/manager. The practice has two treatment rooms, one of which is rented out for physiotherapy services.

The practice is owned by a company, and as a condition of registration must have a person registered with the CQC 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 Medidenta Medical Practice is the dental hygienist and therapist.

During the inspection we spoke with a dentist, the qualified dental nurse, and the dental hygienist and therapist. We checked practice policies and procedures and other records about how the service is managed.

The practice is open from 9am to 5pm Mondays to Fridays.

Our key findings were:

• The provider’s infection prevention and control processes did not reflect published guidance.
• The provider had not established effective processes for managing medicines and materials; several items had passed their expiry dates.
• Staff had received vaccinations against Hepatitis B but the provider had not sought evidence that all clinical staff members were suitably immunised.
• The provider had not established effective systems to help them identify, manage and mitigate risks to patients and staff.

We identified regulations the provider was not complying with. 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.

We carried out this announced inspection on 27 March 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 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 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 providing well-led care in accordance with the relevant regulations.

Background

Medidenta Medical Practice is in Welling in the London borough of Bexley. The practice provides private treatment to patients of all ages.

The practice has a ramp available for people who use wheelchairs and those with pushchairs. Car parking spaces, including those for patients with disabled badges, are available near the practice.

The dental team includes three dentists, a qualified dental nurse, a trainee dental nurse, a dental hygiene therapist, and a compliance adviser. The dental nurses, hygiene therapist and compliance officer also undertook receptionist duties.

The practice has two treatment rooms, one of which is leased to a physiotherapy service.

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. The registered manager at name of practice was the dental hygiene therapist.

On the day of inspection we obtained feedback from 16 patients. This information gave us a positive view of the practice.

During the inspection we spoke with a dentist, the qualified dental nurse, the dental hygiene therapist, and the compliance adviser. We checked practice policies and procedures and other records about how the service is managed.

The practice is open from 10am to 6pm Mondays to Fridays. Later appointments may be available on special request.

Our key findings were:

• The practice was clean and well maintained.
• The practice had infection control procedures which reflected published guidance.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• The practice had systems to help them manage risk.
• The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• The practice had thorough staff recruitment procedures.
• 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.
• The practice had effective leadership. Staff felt involved and supported and worked well as a team.

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

• Review the practice's protocols for completion of dental care records taking into account guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.