We undertook a focused inspection of Mile End Dental Clinic on 17 August 2018. This inspection was carried out to review in detail the actions taken by the registered provider to improve the quality of care and to confirm that the practice was now meeting legal requirements.

The inspection was led by a CQC inspector who was supported by two specialist dental advisers.

We undertook a comprehensive inspection of Mile End Dental Clinic on 26 April 2018 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We found the registered provider was not providing well led care in accordance with the relevant regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can read our report of that inspection by selecting the 'all reports' link for Mile End Dental Clinic on our website www.cqc.org.uk.

When one or more of the five questions are not met we require the service to make improvements and send us an action plan. We then inspect again after a reasonable interval, focusing on the areas where improvement was required.

As part of this inspection we asked:

• Is it well-led?

Our findings were:

Are services well-led?

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

The provider had made improvements in relation to the regulatory breaches we found at our inspection on 26 April 2018.

Background

Mile End Dental Clinic is in Colchester and provides NHS and private treatment to patients of all ages.

There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces, including one space for blue badge holders, are available at the rear of the practice.

The dental team includes eight dentists, eight dental nurses, two dental hygienists, two receptionists, one implant nurse/manager and one practice manager/dental nurse. The practice has six treatment rooms.

The practice is owned by an individual who is the principal dentist there. They have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run.

During the inspection we spoke with one dentists, one dental nurse and the implant nurse manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday from 9am to 5.30pm.

Tuesday from 9am to 5.30pm.

Wednesday from 9am to 7pm.

Thursday from 9 am to 6pm.

Friday from 9am to 5.30pm.

Saturday from 9am to 1.30pm.

Our key findings were:

• The practice was giving due regard to the tests, quality checks and operator training for the cone beam computed tomography (CBCT) machine.
• Staff not directly involved in radiography were provided with information sufficient to ensure their continued safety.
• Suitable systems were in place for the recording, investigating and reviewing of accidents or significant events.
• Systems were in place for recording the servicing and maintenance of equipment used for sedation.
• The provider had appointed a training co-ordinator and training administrator to plan training for staff according to their needs.
• Systems were in place to ensure when sedation was provided this was with a single medication and all equipment and medicines were checked again prior to sedation.
• Staff had undergone ILS (Immediate Life Support) training, the dental nurses had undertaken SAAD (Society for the Advancement of Anaesthesia in Dentistry) training. The principal dentist had undergone advanced life support training.
• The practice had implemented information packs for patients undergoing sedation and for patients’ escorts which detailed what to expect before, during and following the procedure.
• The provider had undertaken a Legionella risk assessment by an external provider on 5 June 2018. We noted recommendations and actions identified in the report had been completed.
• The practice was in the process of re-auditing infection control to ensure the next audit was within six months of the previous April 2018 audit.
• Audit procedures had been reviewed with the practice undertaking regular record keeping audits for all clinicians.
• Patient dental records we looked at had detailed recording procedures, and included medication used and information given to the patient.
• Patient dental records detailed that where scans were taken these were justified by dentists.

We carried out this announced inspection on 26 April 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 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 not providing well-led care in accordance with the relevant regulations.

Background

Mile End Dental Clinic is in Colchester and provides NHS and private treatment to patients of all ages. There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces, including one space for blue badge holders, are available at the rear of the practice.

The dental team includes eight dentists, eight dental nurses, two dental hygienists, two receptionists, one implant nurse/manager and one practice manager/dental nurse. The practice has six treatment rooms.

The practice is owned by an individual who is the principal dentist there. They have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run.

On the day of inspection, we collected 30 CQC comment cards filled in by patients and spoke with one other patient.

During the inspection we spoke with three dentists, one dental nurse, two receptionists, the dental implant nurse manager and the practice manager/dental nurse. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday from 9am to 5.30pm.

Tuesday from 9am to 5.30 pm.

Wednesday from 9am to 7pm.

Thursday from 9 am to 6pm.

Friday from 9am to 5.30pm.

Saturday from 9am to 1.30pm.

Our key findings were:

• We received positive comments from patients about the dental care they received and the staff who delivered it.
• The appointment system met patients’ needs and the practice opened late two evenings a week and Saturdays from 9am to 1.30pm. Text appointment reminders were available.
• The practice was clean and well maintained.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• The clinical staff provided patients’ care and treatment in line with current guidelines.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• The practice staff had suitable safeguarding processes and 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.
• Staff felt involved and supported and worked well as a team.
• The practice asked staff and patients for feedback about the services they provided.
• The practice staff dealt with complaints positively and efficiently.
• Risk assessment to identify potential hazards and audit to improve the service were limited.

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

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

Full details of the regulation the provider was not meeting is at the end of this report.

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

• Review the practice’s protocols to ensure audits of infection prevention and control are undertaken at regular intervals to improve the quality of the service. Practice should also ensure that, where appropriate, audits have documented learning points and the resulting improvements can be demonstrated.
• Review the practice's protocols for completion of dental care records taking into account the guidance provided by the Faculty of General Dental Practice.

We spoke with four people who used the service and were attending appointments. People told us that they were happy with the service that they were provided with. One person said, “It is really good.” Another person said, “I never feel they are rushing (when attending their appointment). They are caring and I am confident they know what they are doing.”

With their permission, we observed three people's appointments. We also observed the interaction between staff and people who used the service when they arrived for their appointments and left the service. We saw that the staff interacted with people in a friendly, respectful and professional manner.

People told us they felt respected by staff and were fully involved in the decisions about their dental care and treatment. One person said, “We discuss what I need, and I make the decision about what I am going to have done.”

We looked at 10 people's records and found that care and treatment was planned and delivered in a way that was intended to ensure their safety and welfare.

People told us that the waiting and treatment areas were always clean and tidy. This was confirmed in what we saw during our inspection. One person said, “It is always clean, I have never seen it any different.”

We found that staff were provided with appropriate training to meet the needs of the people who used the service.

The provider had systems in place to monitor and assess the service they provided to people.