We carried out an announced comprehensive inspection of this service on 19 November 2015 as part of our regulatory functions. 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 undertook this focused inspection on 21 March 2016 to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Mr Declan Thompson – Harley Street on our website at www.cqc.org.uk.

We carried out an announced comprehensive inspection on 19 November 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 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

Mr Declan Thompson – Harley Street is a dental practice located in the London Borough of Westminster. The premises are situated on the first floor of a building where other health care providers are also situated. There is one treatment room, a dedicated decontamination room, an administrative office, and a patient toilet. There is also a shared waiting room with reception area on the ground floor.

The practice provides private services to adults and children. The practice offers a range of dental services including routine examinations and treatment, veneers, crowns and bridges.

The staff structure of the practice comprises a principal dentist (who is also the owner), a dental nurse and a part-time administrator.

The practice opening hours are from 9.00am to 6.00pm, Monday to Friday.

The Care Quality Commission (CQC) previously inspected the practice on 16 January 2014 and asked the provider to make improvements regarding infection control. We checked these areas as part of this comprehensive inspection and found they had been resolved.

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.

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

Eight people provided feedback about the service. Patients were positive about the care they received from the practice. They were complimentary about the friendly and caring attitude of the dental staff.

Our key findings were:

• There were effective systems in place to reduce and minimise the risk and spread of infection.
• The practice had effective safeguarding processes in place and staff understood their responsibilities for safeguarding adults and children living in vulnerable circumstances.
• Some equipment, such as the air compressor and autoclave (steriliser), had been checked for effectiveness and had been regularly serviced; although we noted that some records for other equipment, including the ultrasonic bath were not up to date.
• The practice had implemented clear procedures for managing comments, concerns or complaints.
• Patients indicated that they felt they were listened to and that they received good care from a helpful and caring practice team.
• Staff understood the importance of obtaining informed consent prior to treatment, but did not regularly keep a record of when verbal or written consent had been obtained. Awareness of the needs of higher-risk groups, including young people and those with impaired decision-making capacity, as regards consent processes could be improved.
• The practice ensured staff maintained the necessary skills and competence to support the needs of patients.
• Staff recorded accidents, but there was no system for reporting or recording incidents or significant events.
• The practice had undertaken some relevant checks for the clinical staff at the time of employing them, but there was no formal recruitment policy, and staff did not have current job descriptions or contracts.
• The principal dentist had a vision for the practice and staff told us they were well supported, although staff had not received regular, formal appraisals.
• 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 an effective system is established to assess, monitor and mitigate the various risks arising from undertaking of the regulated activities.
• Ensure the training, learning and development needs of individual staff members are reviewed at appropriate intervals and an effective process is established for the on-going assessment and supervision of all staff.
• Ensure dental care records are maintained appropriately giving due regard to guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.
• Ensure audits of various aspects of the service, such as radiography, infection control and dental care records are undertaken at regular intervals to help improve the quality of service. The practice should also check all audits have documented learning points and the resulting improvements can be demonstrated.

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

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

• Review the practice's recruitment arrangements to ensure they are in line with Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 to ensure necessary employment checks are in place for all staff and the required specified information in respect of persons employed by the practice is held.
• Establish a system for recording, investigating and reviewing incidents or significant events with a view to preventing further occurrences and ensuring that improvements are made as a result.
• Review the practice’s protocols for the use of rubber dam for root canal treatment giving due regard to guidelines issued by the British Endodontic Society.
• Review the protocols and procedures for use of X-ray equipment giving due regard to Guidance Notes for Dental Practitioners on the Safe Use of X-ray Equipment.
• Review staff awareness of, and training in relation to, Gillick competency and the requirements of the Mental Capacity Act (MCA) 2005 and ensure all staff are aware of their responsibilities as it relates to their role.
• Review staff awareness of the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013 (RIDDOR).
• 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).

We spoke to one person using the service, whose relatives also used the service. They told us that treatments were well explained and that they were always given a range of treatment options. They said the costs of treatments were made clear to them. Staff reported that they would discuss different treatment options with patients before providing them and that they would use pictures and drawings explain what they involved. For complex treatments people were provided with a written explanation of what their treatment involved.

When people first attended the practice they were asked to complete a medical history form which asked for relevant details about medical conditions people had, allergies and medications they were currently taking. Staff reported that these details were checked at each appointment and the person we spoke with confirmed this. Emergency drugs and equipment were available and staff had been trained in what to do in a medical emergency.

People were not always protected from the risk of infection because appropriate guidance had not been followed.

Staff undertook the Continuing Professional Development training needed to maintain their professional registrations. They undertook appropriate mandatory training on an annual basis in suitable topics such as what to do in a medical emergency, infection control and radiation protection.

The provider had an effective system to regularly assess and monitor the quality of service that people receive.