We carried out this announced follow-up inspection of Shasgo Dental on 1 December 2017. The inspection was led by a Care Quality Commission (CQC) inspector who was supported by a specialist dental adviser.

At the previous comprehensive inspection on 15 June 2017 we found the registered provider was providing effective, caring and responsive care in accordance with relevant regulations.

We judged the practice was not providing safe or well-led care in accordance with 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 Shasgo Dental 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 1 December 2017 to check they had followed their plan. We reviewed the key question of well-led. We also reviewed the key question of safe, effective and responsive as we had made recommendations to the provider relating to these key questions.

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 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 well-led care in accordance with the relevant regulations.

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

• Review the practice’s protocols for the use of rubber dam for root canal treatment taking into account guidelines issued by the British Endodontic Society.

• Review staff training and the availability of equipment used to manage medical emergencies, taking into account guidelines issued by the Resuscitation Council (UK) and the General Dental Council (GDC) standards for the dental team. In particular this relates to the lack of availability of buccal Midazolam and training on the use of the Automated External Defibrillator (AED).

• 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 15 June 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 not 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

Shasgo Dental is in Sidcup, in the Greater London borough of Bexley. It provides private treatment to patients of all ages.

There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces, including those for patients with disabled badges, are available near the practice.

The dental team includes a dentist, a dental nurse, and a receptionist. The practice has one treatment room.

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 collected 31 CQC comment cards filled in by patients. This information gave us a positive view of the practice.

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

The practice is open on Mondays and Tuesdays from 9.15am to 12.30pm, Wednesdays from 2pm to 5.30pm, and on Thursdays and Fridays from 9.15am to 1pm.

Our key findings were:

• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• The appointment system met patients’ needs.
• Staff knew how to deal with emergencies. Appropriate medicines were available, though some life-saving equipment as per current recommendations was absent.
• The practice was clean and well maintained in most areas, though some improvements were needed to ensure cleaning processes were in line with current guidelines.
• The practice had not established thorough staff recruitment procedures.
• The practice was not able to demonstrate that all staff had received key training.
• The clinical staff provided patients’ care and treatment in line with current guidelines, though improvements were needed to ensure the necessary information was recorded in dental care records.
• The practice had safeguarding processes and staff knew their responsibilities for safeguarding adults and children, though improvements could be made to ensure staff knew whom to report concerns to externally, and policies needed to be updated with key information.
• The practice had not maintained several records pertaining to the running of the service and staff employed at the practice.
• The practice had infection control procedures in place, though improvements were needed to ensure they reflected published guidance.
• Staff felt involved and supported, and worked well as a team, though governance and leadership at the practice required improvements across several areas.

Shortly after the inspection the practice took some steps to begin to address issues identified.

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 persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out their duties.
• Ensure specified information is available regarding each person employed.

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

Furthermore, there were areas where the provider could make improvements. They should:

• Review the practice’s protocols for the use of rubber dam for root canal treatment taking into account guidelines issued by the British Endodontic Society.
• Review the practice's policies to ensure they are fit for purpose.
• Review the practice’s system for documentation of actions taken, and learning shared, in response to incidents with a view to preventing further occurrences and ensuring that improvements are made as a result.
• 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 (GDC).
• Review the protocols and procedures for use of X-ray equipment, taking into account Guidance Notes for Dental Practitioners on the Safe Use of X-ray Equipment.
• Review the practice’s recruitment procedures to ensure persons employed remain of good character.

People we spoke with told us that they were pleased with the dental care they received. They told us that their dentist explained their treatment and the cost to them.

People told us that they felt they received appropriate care and treatment and that they were supported in making decisions related to their treatment.

We were told by one patient that the treatment was first class.