We carried out a follow- up inspection on 25 August 2017 at Primrose Dental Practice

We had undertaken an announced follow-up inspection of this service on 10 March 2017 as part of our regulatory functions where breach of legal requirements were found.

After the follow up inspection, the practice wrote to us to say what they would do to meet the legal requirements in relation to the breach.

We revisited Primrose Dental Practice as part of this review and checked whether they had followed their action plan.

We reviewed the practice against four of the five questions we ask about services: is the service safe, effective, responsive and well-led? 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 Primrose Dental Practice on our website at www.cqc.org.uk.

Background

This inspection was planned to check whether the practice was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The follow up inspection was led by a CQC inspector who was supported by a specialist dental adviser.

During our inspection visit, we checked that points described in the provider’s action plan had been implemented by looking at a range of documents such as risk assessments, staff files, policies, procedures and staff training. We also carried out a tour of the premises.

Our key findings were:

• The practice had infection control procedures which reflected published guidance.

• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.

• The practice had systems to help them manage risk.

• The practice had thorough staff recruitment procedures.

• The clinical staff provided patients’ care and treatment in line with current guidelines.

• The practice had effective leadership. Staff felt involved and supported and worked well as a team.

We carried out an unannounced follow- up inspection at Primrose Dental Practice on the 10 March 2017.

This followed inspections on 3 August 2016 and 21 March 2016 carried out as part of our regulatory functions where breaches of legal requirements were found. Following our last inspection we had imposed conditions on the provider in regards to undertaking of dental implant surgery.

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 responsive?

We found that this practice was not 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

We are considering our enforcement actions in relation to the regulatory breaches identified. We will report further when any enforcement action is concluded.

You can read the reports from our previous inspection by selecting the 'all reports' link for Primrose Dental Ltd on our website at www.cqc.org.uk.

Our key findings were:

• The practice did not have arrangements in place to ensure the safety of products used.

• There was a lack of an effective system to assess, monitor and mitigate the risks relating to the health, safety and welfare of patients, staff and visitors.

• There was a lack of effective processes for acknowledging, recording, investigating and responding to complaints, concerns and suggestions made by patients.

• There was a lack of systems in place to ensure staff were appropriately trained.

• Governance arrangements in place were not effective to facilitate the smooth running of the service.

We carried out a follow- up inspection on 3 August 2016 at Primrose Dental Practice.

We had undertaken an announced comprehensive inspection of this service on 21 March 2016 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. This report only covers our findings in relation to those requirements and we reviewed the practice against four of the five questions we ask about services: is the service safe, effective, responsive and well-led?

We revisited Primrose Dental practice as part of this review and checked whether they had followed their action plan and to confirm that they now met the legal requirements.

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 responsive?

We found that this practice was not 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

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

We carried out an announced comprehensive inspection on 21 March 2016 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 not 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

Primrose Dental Practice is located in the London Borough of Camden and provides private dental treatment to both adults and children. The premises are on the first floor above retail premises and consist of three treatment rooms, a reception area and a dedicated decontamination room. The practice is open on Monday - Friday 9:00am – 4:30pm.

The staff consists of the principal dentist, one associate dentist, one dental hygienist, three dental nurses and one trainee dental nurse.

The principal dentist is the registered manager. A registered manager is a person who is registered with the Care Quality Commission 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.

We reviewed ten CQC comment cards. Patients were positive about the service. They were complimentary about the friendly and caring attitude of the staff.

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

Our key findings were:

• There were appropriate equipment and access to emergency drugs to enable the practice to respond to medical emergencies. Staff knew where equipment was stored.

• Patients had good access to appointments including emergency appointments.

• We observed staff to be caring, friendly, reassuring and welcoming to patients.

• There was lack of appropriate systems in place to safeguard patients

• The practice did not have arrangements in place to ensure the safety of the equipment.

• There was a lack of effective arrangements in place to meet the Control of Substances Hazardous to Health 2002 (COSHH) Regulations.

• Staff did not receive appropriate support and appraisal as is necessary to enable them to carry out their duties.

• There was a lack of effective processes for acknowledging, recording, investigating and responding to complaints, concerns and suggestions made by patients.

• There was a lack of an effective system to assess, monitor and improve the quality and safety of the services provided.

• There was a lack of an effective system to assess, monitor and mitigate the risks relating to the health, safety and welfare of patients, staff and visitors.

• Governance arrangements in place were not effective to facilitate the smooth running of the service and there was no evidence of audits being used for continuous improvements.

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

• Ensure that the practice has and implements, robust procedures and processes that make sure that people are protected from abuse.

• Ensure that the equipment used by the service provider for providing care or treatment to a service user is safe for such use and is used in a safe way.

• Ensure the practice's recruitment policy and procedures are suitable and the recruitment arrangements 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.

• Ensure systems are put in place for the proper and safe management of medicines.

• Ensure staff training 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.

• Ensure the practice’s infection control procedures and protocols are suitable 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’

• Ensure that the practice is in compliance with its legal obligations under Ionising Radiation Regulations (IRR) 99 and Ionising Radiation (Medical Exposure) Regulation (IRMER) 2000.

• 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 that the registered person establishes and operates effectively an accessible system for identifying, receiving, recording, handling and responding to complaints by service users.

• 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.

• Ensure the practice establishes an effective system to assess, monitor and mitigate the various risks arising from undertaking of the regulated activities.

• 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.

There were areas where the provider could make improvements and 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 its responsibilities to respond to the needs of patients with disability and the requirements of the Equality Act 2010 and ensure a Disability Discrimination Act audit is undertaken for the premises.

• The principal dentist was made aware of these findings on the day of the inspection and they were also formally notified of our concerns immediately after the inspection. They were given an opportunity to put forward an urgent action plan with remedial timeframes, as to how the risks could be reduced to ensure patient safety.