We carried out this announced inspection on 05 July 2018. The inspection was led by a Care Quality Commission (CQC) inspector who was supported by a specialist dental advisor.

At the previous comprehensive inspection on 20 December 2017 we found the registered provider was providing safe, effective, caring and responsive care in accordance with relevant regulations. We judged the practice was not providing well-led care in accordance with regulations 17 and 19 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 NW1 Dentalcare on our website www.cqc.org.uk.

The provider submitted an action plan to tell us what they would do to make improvements. We undertook this inspection on 05 July 2018 to check that they had followed their plan. We reviewed the key question of whether the practice was well-led.

Our findings were:

Are services well-led?

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

We carried out this announced inspection on 20 December 2017 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 Care Quality Commission (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

NW1 Dentalcare is in Camden, London. The practice provides private treatment to patients of all ages.

There is level access for people who use wheelchairs and pushchairs. Restricted car parking spaces are available near the practice.

The dental team includes seven dentists, two qualified dental nurses who also undertake receptionist duties, four trainee dental nurses and a receptionist. The practice has two treatment rooms and the building is arranged over the ground and basement floors of a converted building.

The practice is owned by a company and as a condition of registration must have a person registered with the Care Quality Commission as the registered manager. Registered managers 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 registered manager at name of practice was the principal dentist.

On the day of inspection we obtained feedback from 31 patients. This information gave us a positive view of the practice.

During the inspection we spoke with two dentists, a trainee dental nurse and a qualified dental nurse who had receptionist duties. We checked practice policies and procedures and other records about how the service is managed.

The practice is open at the following times:

Mon, Weds: 9am-7pm

Tue, Thurs, Fri: 9am-6pm

Sat: 10am-3pm

Our key findings were:

• The practice appeared clean and well maintained.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• The practice had 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.
• The appointment system met patients’ needs.
• 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 dealt with complaints positively and efficiently.
• The practice had infection control procedures; improvements could be made to ensure they reflected published guidance in all areas.
• Improvements could be made to establish a process for receiving safety alerts and for managing significant events.
• Improvements could be made to the practice’s staff recruitment procedures.
• Improvements could be made to ensure all dentists recorded the necessary information in dental care records.
• Risks from the lack of robust recruitment checks, and the lack of systems to monitor quality had not been suitably identified and mitigated

The provider assured us following our visit that they would address these issues and put immediate procedures in place to manage the risks. We have since been sent evidence to show

that improvements are being made. However, as various documents were not available for inspection we were not able to comment on their completeness and accuracy. We have though noted the information and it will be reflected once we carry out a follow-up inspection at the practice.

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.
• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.

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

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

• Review the practice's protocols for completion of dental care records taking into account guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.
• Review its responsibilities to meet the needs of people with a disability, including those with hearing difficulties and the requirements of the Equality Act 2010.
• Review the availability of interpreter services for patients who do not speak English as a first language.