We undertook a follow up focused inspection of Perivale Dental Practice on 18 March 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 CQC inspector who had access to remote support of a specialist dental adviser.

We undertook a comprehensive inspection of The Perivale Dental Practice on 13 August 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 r well led care and was in breach of regulation 17 – Good governance 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 Perivale Dental Practice on our website www.cqc.org.uk.

Following our inspection on 13 August 2018 the dental provider sent us a plan of actions detailing how they would make the required improvements.

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

Our findings 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 breach we found at our inspection on 13 August 2018.

Background

Perivale Dental Practice is in Perivale in the London Borough of Hillingdon. The practice provides NHS and private treatment to patients of all ages.

The practice has two treatment rooms, both located on the ground floor; one was in use at the time of our inspection. The practice is situated close to public transport bus and train services.

The dental team includes the principal dentist and one associate dentist. One trainee dental nurse and dental hygienist also work at the practice. The clinical team are supported by a receptionist.

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 and the receptionist. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Mondays to Fridays between 9am and 5.30pm.

Saturdays between 9am and 5.30pm for dental hygiene appointments only.

Our key findings were:

• The practice infection control procedures had been reviewed and improved so that infection prevention and control audits were carried out taking into account guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices and have regard to The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance’. The findings of these audits were used to monitor and make improvements to the practice procedures where this was indicated.

• There were effective arrangements ensuring that equipment used to sterilise dental instruments was serviced and maintained in line with the manufacturer’s instructions and taking into account the guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices and have regard to The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance’.

• There were effective arrangements for assessing and mitigating risks associated with fire and ensuring that fire safety equipment was regularly checked, tested and maintained in line with the manufacturer’s instructions.

• Dental radiograph audits were carried in line with the Ionising Radiation (Medical Exposure) Regulations (IRMER) 2017 and relevant national guidance to ensure the quality of grading, justification and reporting in relation to dental radiographs.

• There were suitable systems in place to deal with medical emergencies. The recommended life-saving equipment and medicines were available and staff had completed training in medical emergencies.

• Information in relation to safety including patient safety alerts, recalls and rapid response reports issued from the Medicines and Healthcare products Regulatory Agency (MHRA) were reviewed and shared to help monitor and improve safety.

• The practice’s sharps procedures were in compliance with the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.

• The practice had reviewed its protocols for assessing and mitigating risks where clinical staff such as the dental hygienist work without chairside support.

• There were arrangements in place to monitor the security of prescription pads in to track and monitor their use.

• There were arrangements in place to monitor routine and urgent referrals.

• The practice considered the needs of patients who may need additional support and had made reasonable adjustments

We carried out this announced inspection on 13 August 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 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

Perivale Dental Practice is in Perivale in the London Borough of Hillingdon. The practice provides NHS and private treatment to patients of all ages.

The practice has two treatment rooms, both located on the ground floor; one was in use at the time of our inspection. The practice is situated close to public transport bus and train services.

The dental team includes the principal dentist and one associate dentist. One trainee dental nurse and dental hygienist also work at the practice. The clinical team are supported by a receptionist.

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 received feedback from 26 patients.

During the inspection we spoke with the principal dentist, the trainee dental nurse and the receptionist. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Mondays to Fridays between 9am and 5.30pm.

Saturdays between 9am and 5.30pm for dental hygiene appointments only.

Our key findings were:

• The practice appeared clean.
• The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• The practice had thorough staff recruitment procedures.
• The clinical staff provided patients’ care and treatment in line with current guidelines.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• The practice was providing preventive care and supporting patients to ensure better oral health.
• 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 suitable information governance arrangements.
• The practice had clearly defined leadership. There were some systems to help them assess and manage risk. However these were not always consistent or in line with current guidance and legislation.
• The practice had infection control procedures which reflected published guidance. Improvements were needed so that infection control audits were carried out in line with current guidance.
• Staff knew how to deal with emergencies. Improvements were needed to ensure that appropriate medicines and life-saving equipment were available.
• Improvements were needed to the systems for checking, servicing and maintenance of equipment taking into account current national guidance and ensure that all equipment is well maintained.

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.

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 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 practice’s sharps procedures and ensure the practice is in compliance with the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.
• Review availability of medicines and equipment to manage medical emergencies taking into account guidelines issued by the British National Formulary, the Resuscitation Council (UK), and the General Dental Council (GDC) standards for the dental team.
• Review the practice protocols for assessing and mitigating risks where clinical staff such as the dental hygienist work without chair side support.
• Review the security of prescription pads in the practice and ensure there are systems in place to track and monitor their use.
• Review the practice’s protocols for referral of patients and ensure all referrals are monitored suitably.
• Review its responsibilities to respond to the needs of patients with disability and the requirements of the Equality Act 2010.

People said they had been told about the treatments available and the costs involved, so they could make an informed choice. People said that staff were respectful and treated them with consideration and dignity. People we spoke with said the practice was always clean and that staff wore gloves, masks and aprons. They told us they were satisfied with the service they received and felt comfortable to raise any concerns they may have with the dentist or the practice manager. Comments included “I’m 100% happy with the service”, “my dentist knows my dental and medical history very well”.