We carried out an announced comprehensive inspection of this service on 27 July 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 9 May 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 Unique Dental Care as part of this review.

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

We carried out an announced comprehensive inspection on 22 July 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 not 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

Unique Dental Care is located in the London Borough of Lambeth. It is a subsidiary of Southern Dental, an organisation that owns a number of dental locations in London and the South of England. The premises consist of three treatment rooms and one dedicated decontamination room. There are also toilet facilities, a waiting area, a reception area, an administrative office and a staff kitchen area.

The practice provides care to both NHS and private patients, and treats both adults and children. The practice offers a range of dental services including examinations, treatment and dental hygiene.

At the time of the inspection, the staff in the practice consisted of two dentists, and a hygienist who worked in the practice one day per week. There were also three nurses at the practice, all of whom were trainees. There was a practice manager and a receptionist. A senior member from the organisation had made themselves available at the practice on the day of our inspection. The practices opening hours are 9am – 6pm Monday to Friday and 9am – 3pm on Saturdays

At the time of the inspection the practice manager was the registered manager at the practice. 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 lead inspector and a dental specialist adviser.

We received no Care Quality Commission feedback cards which had been left with the practice in the two weeks leading up to the inspection. We spoke to three patients during the visit who stated that they were happy with the care which they had received.

Our key findings were:

• Patients were assessed and treated in line with National Institute for Health and Care Excellence (NICE) guidance.
• The practice worked with other providers to ensure that co-ordinated care was provided for patients.

• Recruitment policies in the practice were appropriate, and relevant checks were carried out.

• There were limited processes in place to identify report and learn from incidents.

• The practice did not have adequate infection control processes and procedures.

• There was equipment in the practice that was not appropriately maintained.

• There were limited governance procedures in place at the practice.

• The practice did not have sufficient policies and procedures to mitigate risk.

• The practice did not demonstrate active learning from the care provided to patients. This included limited involvement in audit.

• There were no staff appraisals in place at the practice, and staff training was not managed appropriately. There were no comprehensive records of training undertaken by staff.

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

• Review the practice’s infection control procedures and protocols 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’.
• 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 the practice’s protocols for undertaking radiography giving due regard to the Ionising Radiation (Medical Exposure) Regulations (IR(ME)R) 2000 and Ionising Radiation Regulations (IRR) 1999.

• Ensure that staff inductions and appraisals are formalised and in place and that they are supported with formal meetings with all staff.

• Ensure that structured governance arrangements supported by clear policies and procedures are in place at the practice, and ensure that all staff are aware of these

• Ensure that there is clarity on the responsibility of strategic leadership in the practice. This must include having clearly defined leadership roles within the practice for safeguarding and clinical issues.

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 protocols for the use of rubber dam for root canal treatment giving due regard to guidelines issued by the British Endodontic Society.

• Review the practice’s protocols for recording in the patients’ dental care records or elsewhere the reason for taking the X-ray and quality of the X-ray giving due regard to the Ionising Radiation (Medical Exposure) Regulations (IR(ME)R) 2000.

• Monitor and record the temperature of the fridge where dental products and medicines are stored to ensure temperatures remain within the recommended range.

• Ensure all staff are aware of their responsibilities under the Mental Capacity Act (MCA) 2005 as it relates to their role.
• Review the suitability of all areas of the premises and the fixtures and fittings, specifically carpets that might be a trip hazard, and access for patients with disabilities