We carried out an announced comprehensive inspection of this service on 30 September 2015 as part of our regulatory functions where a breach of legal requirements was found. After the comprehensive inspection, the practice wrote to us to say what they would do to meet the legal requirements in relation to the breach.

We carried out a follow- up inspection on 11 January 2016 to check that they had followed their plan and to confirm that they now met the legal requirements. This report only covers our findings in relation to those requirements. We revisited the Mitcham International Dental Practice as part of this review.

You can read the report from our last comprehensive inspection by selecting the 'all reports' link for Mitcham International Dental Centre on our website at www.cqc.org.uk.

We carried out an announced comprehensive inspection on 30 September 2015 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 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

Mitcham International Dental Centre is located in the London Borough of Merton. The premises consist of six treatment rooms, a decontamination room and a waiting room with reception area.

The practice provides both NHS and private dental services and treats both adults and children. The practice offers a range of dental services including routine examinations and treatment, veneers, crowns and bridges, and oral hygiene.

The practice staffing consists of six dentists and six dental nurses. This includes two principal dentists (who were also the owners).

The practice is open Monday to Thursday 8:30am to 5:00pm and Friday 8:30am to 3:00pm.

One of the principal dentists is the registered manager. A registered manager is a person who is registered with the Care Quality Commission (CQC) to manage the service. 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.

The inspection took place over one day and was carried out by a CQC inspector and a dentist specialist advisor.

We collected feedback from 15 patients via CQC comment cards. They all described a positive view of the service. Patients commented that the whole team were welcoming, professional, caring, respectful and friendly.

Our key findings were:

• Patients’ needs were assessed and care was planned in line with current guidance such as from the National Institute for Health and Care Excellence (NICE).

• Patients indicated that they felt they were listened to and that they received good care from a helpful and caring practice team.

• The practice had procedures for managing concerns and complaints.

• There was no system for reporting or recording incidents or significant events.
• There was lack of regular checks to ensure equipment to manage medical emergencies was suitable for use.
• The practice had undertaken some relevant checks for clinical staff at the time of employing them, but there was no formal recruitment policy,
• Governance arrangements were in place for the running of the practice; however the practice did not have a structured plan in place to assess various risks arising from undertaking the regulated activities and to effectively audit quality and safety.

We identified regulations that were not being met and the provider must:

• Ensure the practice’s infection control procedures and protocols are suitable giving due regard to guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices and The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance’.
• Establish an effective system to assess, monitor and mitigate the risks relating to the health, safety and welfare of patients, staff and visitors.
• Ensure all staff receive necessary training and performance appraisals and are suitably supported in undertaking their activities.

You can see full details of the regulations not being met at the end of this report.

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

• Review availability of equipment to manage medical emergencies giving due regard to guidelines issued by the Resuscitation Council (UK), and the General Dental Council (GDC) standards for the dental team.
• Review governance arrangements including the effective use of risk assessments, audits, such as those for infection control, radiographs and dental care records, and staff meetings for monitoring and improving the quality of the care received.
• Review recruitment procedures to ensure accurate, complete and detailed records are maintained for all staff.

• Review the practice’s arrangements for receiving and responding to patient safety alerts, recalls and rapid response reports issued from the Medicines and Healthcare products Regulatory Agency (MHRA) and through the Central Alerting System (CAS), as well as from other relevant bodies, such as Public Health England (PHE).
• Review the suitability of all areas of the premises and the fixtures and fittings in the treatment rooms and ensure safety.
• Review the practice's protocols for completion of dental care records giving due regard to guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.

• Review the protocols and procedures to ensure staff are up to date with their mandatory training and their Continuing Professional Development (CPD).

• Review staff awareness of the requirements of the Mental Capacity Act (MCA) 2005 and ensure all staff are aware of their responsibilities under the Act as it relates to their role.

• Review its systems to seek and act on patient and staff feedback.