We undertook this follow-up focused inspection on 17 April 2019. 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 Care Quality Commission (CQC) inspector who was supported by a specialist dental adviser.

We previously undertook a comprehensive inspection on 19 September 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 and was in breach of Regulation 17 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 Oralon Dental on our website www.cqc.org.uk.

As part of this inspection we asked:

• Is it well-led?

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 the service again after a reasonable interval, focusing on the areas where improvement was required.

Our findings during this inspection 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 breaches we found during the previous inspection on 19 September 2018.

Background

Oralon Dental is in the London Borough of Southwark and provides private treatment to patients of all ages.

The dental team includes four dentists, a qualified dental nurse, a treatment coordinator (who also undertakes receptionist duties and is a qualified dental nurse), a dental hygienist and a practice manager.

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 the principal dentist, a dental nurse, the treatment coordinator, and the practice manager. We checked practice policies and procedures and other records about how the service is managed.

The practice is open Monday to Friday between 8.15am and 9pm.

Our key findings were:

The provider had established systems and processes to ensure good governance in accordance with the fundamental standards of care. They had:

• Improved their systems for recruiting staff to ensure the necessary background checks were completed.
• Carried out radiography and infection control audits to monitor and improve the quality of the services being provided.
• Assessed the risks associated with a member of clinical staff working without chairside support.
• Ensured that all staff completed key training and established systems to ensure training would be suitably monitored.
• Reviewed the training, learning and development needs of staff members and established a process for the ongoing assessment, supervision and appraisal of the practice’s staff.
• Reviewed health and safety, fire and Legionella risk assessments and implemented improvements.
• Reviewed the practice’s protocols for recording, investigating and reviewing national patient safety alert, recalls and rapid response alerts.
• Implemented protocols for monitoring and recording the fridge temperature to ensure that medicines and dental care products were being stored in line with the manufacturer’s guidance.

There was an area where the provider could make improvements. Some dental care records lacked detail. The provider 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.

We carried out this announced inspection on 19 September 2018 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 providing not well-led care in accordance with the relevant regulations.

Background

Oralon Dental is based in the London Borough of Southwark and provides private treatment to patients of all ages.

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

The dental team includes three dentists, a dental hygienist, a qualified dental nurse, a treatment coordinator (who also undertakes receptionist duties and is a qualified dental nurse), and a practice manager. 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.

On the day of inspection, we obtained feedback from 61 patients.

During the inspection we spoke with the principal dentist, a dental nurse, and the practice manager. We checked practice policies and procedures and other records about how the service is managed.

The practice is open Monday to Friday between 8.15 am and 9pm.

Our key findings were:

• Patients gave us positive feedback about all aspects of the service.
• The practice appeared clean and well maintained. They had infection prevention and control procedures.
• Staff knew how to deal with emergencies. Medicines and life-saving equipment were available.
• The practice had processes to safeguard vulnerable safeguard adults and children.
• The practice was providing preventive care and supporting patients to ensure better oral health.
• The practice had suitable information governance arrangements.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• The practice had systems to enable them to deal with complaints efficiently.
• Staff felt involved and supported and worked well as a team.
• We found there was a lack of assessment, identification, mitigation and monitoring of risks, and a lack of effective governance. The practice had not established effective systems to enable them to monitor and improve the quality of the services being provided.

We identified a regulation the practice was not meeting. They must:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

There are areas where the practice could make improvements. They should:

• Review the current staffing arrangements to ensure all dental care professionals are adequately supported by a trained member of the dental team when treating patients in a dental setting taking into account the guidance issued by the General Dental Council.
• Review the training, learning and development needs of individual staff members at appropriate intervals and ensure an effective process is established for the on-going assessment, supervision and appraisal of all staff.
• 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 the health and safety risk assessment.
• Review the practice’s system for recording, investigating and reviewing incidents or significant events, and review the practice’s arrangements for receiving and responding to national patient safety alerts, recalls and rapid response alerts.
• Review the practice's protocols for monitoring and recording the fridge temperature to ensure that medicines and dental care products are being stored in line with the manufacturer’s guidance.