We undertook a follow up focused inspection of Minty Pearls Dental Clinic on Friday 12 October 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 a specialist dental adviser.

We undertook an inspection of Minty Pearls Dental Clinic on 3 November 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 Minty Pearls 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 area 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 breach we found at our inspection on 3 November 2017.

Background

Minty Pearls Dental Clinic is in (Norbury in the London Borough of Croydon) and provides NHS and private treatment to adults and children.

There is level access for people who use wheelchairs and those with pushchairs.

The dental team includes one dentist, one dental nurse and a practice manager (who also provides reception cover). The practice has two 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 all three staff. We looked at practice policies and procedures and other records about how the service is managed.

Our key findings were:

• The practice appeared 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 asked staff and patients for feedback about the services they provided.
• The practice had suitable information governance arrangements.

We carried out a focused inspection of Minty Pearls Dental Clinic on 3 November 2017.

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

We carried out this inspection focusing only on the well-led key question to check on information we had received relating to this aspect of care at this practice.

Our findings were:

Are services well-led?

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

Our key findings were:

• Some items of life-saving equipment and medicines as per current national guidelines were were past their expiry date and staff were not trained in the use of the Automated External Defibrillator (AED).
• The practice had some systems to help them assess and manage risk. These were not always consistent or in line with current guidance and legislation.
• Infection control procedures did not reflect current published guidance as we noted that the decontamination room was also being used as a kitchen.
• There was no evidence that the practice were gathering feedback from patients or participating in the NHS Friends and Family Test (FFT).

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

We carried out an announced comprehensive inspection on 2 November 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 providing well-led care in accordance with the relevant regulations

Background

Minty Pearls Dental Clinic is a mixed NHS and private dental practice in Croydon. The practice is a commercial site on a main road. It is set out over one level on the ground floor. There are two dental treatment rooms and a separate decontamination room for cleaning, sterilising and packing dental instruments. In addition there is a reception and waiting area for patients.

The practice is open 9.00am – 6.00pm Monday to Thursday; 9.00am to 4.00pm on Fridays and 10.00am to 2.00pm on Saturdays. The practice has one dentist and is supported by three part-time dental nurses (who also provide reception duties).

The principal dentist is registered with the Care Quality Commission (CQC) as an individual. 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.

Our key findings were:

• All staff had been trained to handle emergencies. There was equipment for staff to undertake their duties, and equipment was well-maintained. However the practice did not have access to an automated external defibrillator
• The practice appeared clean and well maintained.
• Infection control procedures were in place but improvements were required to ensure published guidance was being followed suitably.
• Flooring in both surgeries needed improvement as it was worn-out in places
• The practice had a safeguarding lead with information available to staff to refer to. Staff demonstrated knowledge of safeguarding.
• The practice had systems in place for reporting incidents.
• Dentists provided dental care in accordance with current professional and National Institute for Health and Care Excellence (NICE) guidelines.
• The service was aware of the needs of the local population and took these into account in how the practice was run.
• Patients could access treatment and urgent and emergency care when required.
• Governance arrangements were in place for the smooth running of the practice; however the practice did not have a structured plan in place to carry out risk assessments, staff meetings or staff appraisals for development.

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

• Review systems to assess, monitor and mitigate the various risks arising from undertaking of the regulated activities.
• Review availability of medicines and equipment to manage medical emergencies taking into account guidelines issued by the Resuscitation Council (UK), and the General Dental Council (GDC) standards for the dental team.
• 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 its audit protocols to ensure audits of various aspects of the service, including infection prevention and control are undertaken at regular intervals to help improve the quality of service. Practice should also ensure, that where appropriate audits have documented learning points and the resulting improvements can be demonstrated.

On the day of our inspection we spoke with one person using the service. They told us they had been attending the practice for twelve years and the staff were friendly and helpful. They said their privacy was respected and the practice was always clean a tidy.

We found people’s views were taken into account in the way the service was provided and delivered in relation to their treatment. People were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. People were protected from the risk of infection because appropriate guidance had been followed. We also found that there was an effective complaints system available.