We visited the Dentist on 14 June 2013. We looked around the surgery. The areas were clean light bright and inviting. We saw evidence of leaflets and posters on display in the reception area for patients who used the service.

We spoke with two patients who used the service. Both were complementary about the care they received. One person said “All procedures and treatment options and fees are explained, I have received very good treatment I was reassured by the dentist when I was worried”. Another person told us “The staff are very good at explaining everything they are friendly and helpful”.

We saw that staff had access to the in house safeguarding policy and there was access to the local authority safeguarding guidance and a flow chart for staff to follow.

We looked around the surgery. The clinic was clean and tidy. We spoke with patients who used the service. One patient said “The surgery is clean, it is a nice environment”.

We looked at two staff files and saw evidence of some training undertaken both had evidence of an induction checklist which included, infection control, fire, health and safety, resuscitation and complaints.

We spoke with patients who used the service and received positive feedback. Some comments received were “The staff are all very professional, I never have any concerns and feel able to approach with any concerns”. And “The manager is very good”.

Re-Enhance is operated by Re-Enhance Limited. The service offer cosmetic day case services for surgery (liposuction procedures), dental treatments and medicine services (bio-identical hormone therapies) for adults. Facilities include four treatment rooms and diagnostic facilities. The service provides surgery, medicine and dental services.

Following our inspection on 1 and 14 March 2017 we issued warning notices against the registered manager and nominated individual. The warning notices were issued as a result of regulatory breaches relating to safe care and treatment, good governance, fit and proper persons employed and staffing.

We carried out this unannounced focussed inspection to see if the clinic had met the concerns we raised in the warning notice following our inspection in March 2017.

At the previous inspection on 1 and 14 March 2017 we found the following issues that the service provider needed to improve:

• Staff did not have current statutory training in key areas such as health and safety, manual handling, fire safety and infection control. Staff also did not have current safeguarding training.
• The system to learn from and make improvements following any accidents, incidents or significant events required improvement.
• The clinic did not have any standard operating procedures for bio-identical hormones and did not reference applicable guidance.
• Whilst patients’ needs were assessed and their care was planned and delivered in line with the clinical lead’s range of course guidance materials, patients’ records did not demonstrate how the clinic complied with these standards and how decisions were made.
• At the time of our inspection, audits were not undertaken to monitor compliance with guidance and standards.
• At the time of our inspection, outcomes of people’s care and treatment were not routinely collected and monitored.
• Patient records were not completed in line with the GMC guidance on good record keeping. They lacked evidence of comprehensive pre-assessment and clinical reasoning for decision-making was not contained within patients’ medical records.
• There was no documented process for referring patients on to services such as counselling, if needed.
• The provider did not have a clear governance framework and management could not evidence that they regularly reviewed the systems that were in place.
• There was not a comprehensive assurance system and service performance measures in place at the time of our inspection.
• The provider did not have arrangements in place to collate information to monitor and manage quality and performance.
• Not all staff that were registered with the General Dental Council (GDC) could provide evidence that met the requirements of their professional registration by carrying out regular training and continuing professional development (CPD).

We inspected this service on 30 May 2017 to check whether improvements had been made. At this inspection we found that the clinic had met the requirements of the warning notice because:

• Managers had a clear oversight of the issues we had previously identified and had put in place systems and processes to address them.
• Immediate patient safety issues had been addressed. Medicines and other consumable items were stored and handled appropriately. There were systems in to monitor and audit infection prevention and control processes.
• Patient records had been revised and included relevant information such as risk assessments, medical histories and details of prescribed medication.
• Equipment used for patient treatment, including emergency equipment, was available and checked on a routine basis.
• Recruitment processes were clearly defined. Staff had completed their mandatory training and annual appraisals. Staff competencies were assessed and reviewed.
• Senior staff had developed an evidence-based governance structure. Risk assessments for staff had been developed. A risk register was in place to enable leaders within the clinic to have an oversight of key risks to the service.

Ellen Armistead

Deputy Chief Inspector of Hospitals (North)