We carried out an unannounced focused inspection on 31 March 2016 to follow up on previous inspections carried out on 11 November and 26 November 2015 to ask the practice the following key questions; Are services safe, effective, 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 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

Background

CQC inspected the practice on 11 November and 26 November 2015 and asked the provider to make improvements regarding Regulation 10 HSCA (RA) Regulations 2014 Dignity and respect, Regulation 12 HSCA (RA) Regulations 2014 Safe care and treatment, Regulation 15 HSCA (RA) Regulations 2014 Premises and Equipment and Regulation 17 HSCA (RA) Regulations 2014 Good governance. We checked these breaches as part of the focused inspection on 31 March 2016.

Clinic Nine provides private dental treatment, facial aesthetics and orthopaedic foot surgery from their clinic in Hove, near Brighton. The majority of the dental treatment provided is implants with some general dentistry. The practice mostly provides treatment for adults but has a very small number of patients that are children.

Practice staffing consisted of the principal dentist who is also the owner and registered manager, an associate dentist, an orthopaedic surgeon, one dental nurse, a clinic co-ordinator and a practice 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.

The practice opening hours are 9.00am to 6.00pm Monday to Friday.

Our key findings were:

• The practice had systems and processes in place to record, investigate, respond to and learn from significant events. However, staff had limited knowledge of what constituted a significant event.
• The practice held regular staff meetings and formal staff appraisals.
• The practice had carried out audits in key areas, such as infection control, record keeping and the quality of X-rays.
• There were systems in place to check all equipment had been serviced and maintained regularly, including the steriliser and the X-ray equipment.
• The provider used an unregistered laboratory for crowns, bridges, implants and dentures.
• Dental care records were consistent and contained accurate information of the treatments provided to patients.
• Staff did not follow the appropriate decontamination process of instruments according to national guidelines.
• Staff recruitment files did not contain all of the necessary employment checks for staff.
• There was no process in place to assess the risks in relation to the Control of Substances Hazardous to Health (COSHH) 2002 regulations.
• Staff had received further training appropriate to their roles and were supported in their continued professional development (CPD).

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

• Ensure that staff demonstrate an appropriate understanding of their responsibilities in relation to RIDDOR and the reporting, recording and learning from significant events.
• 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 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 procedures are in place to assess the risks in relation to the Control of Substances Hazardous to Health (COSHH) 2002 regulations.
• Ensure the laboratory used for the commission of dental appliances is formally registered with the Medicines and Healthcare products Regulatory Agency (MHRA).

You can see full details of the regulations not being met at the end of this report.

We re-visited Clinic Nine to review the steps that the provider had taken following our inspection on the 19 August 2013, when we had identified urgent actions that the provider needed to take. It should be noted that the provider responded with immediate actions to address these concerns and was able to demonstrate that there had been a full and comprehensive review of the service.

On the day of our follow up inspection there were no patients attending the clinic. This enabled us to look at all areas of the premises and speak comprehensively with the provider and the clinic co-ordinators.

We reviewed policies, procedures and looked at a range of records. We looked in particular at the records that related to the employment of staff and the arrangements for engaging clinical practitioners at the clinic. Since our last visit we found that the provider had undertaken a great deal of work to ensure that evidence was in place to demonstrate that all members of staff were appropriately qualified and competent to carry out their role and met the needs of patients using the service. We found that the provider had undertaken appropriate checks on staff and practitioners engaged under practising privileges. There were references and documentation in place for each member of staff and these were available for scrutiny as required under Schedule 3 of the Health and Social Care Act 2008.

We found that since our last visit the provider had undertaken a full review of the procedures that it had in place to ensure that patients were protected from the risk of infection. This included records to demonstrate that all equipment was decontaminated and sterilised in line with the appropriate guidance. When we spoke with staff they were clear on the procedures to be adopted and the checks to be undertaken to ensure that patients were protected from the risk of infection.

Information was available to staff about the procedures to follow if there were any concerns that people were at risk of abuse. Staff had received appropriate safeguarding training and were knowledgeable about the correct procedures to follow if they had concerns.

The provider was able to demonstrate that patients were protected from the risks of unsafe or inappropriate care because clear and comprehensive records were maintained.

On the day of our inspection there were no patients attending the clinic. We were able to look at all areas of the premises and speak with the provider and the clinic co-ordinator.

We reviewed policies, procedures and looked at a range of records. We looked in particular to the records that related to the employment of staff and clinical practitioners that worked at the clinic. The provider was unable to provide evidence that these staff were appropriately qualified and competent to carry out their role and meet the needs of patients using the service. We found that the provider had not undertaken appropriate checks on staff or ensured that references and documentation was in place as required under Schedule 3 of the Health and Social Care Act 2008.

We found the clinic to be clean but were concerned that the provider was not protecting patients from the risk of infection because appropriate guidance had not been followed.

There was no information provided to staff about the procedures to follow if there were any concerns that people were at risk of abuse. Staff had not received appropriate safeguarding training and were not knowledgeable about the correct procedures to follow if they had concerns.

The provider had a system in place to respond to comments and complaints made by patients about the service.

On the day of our visit there were no patients available to speak with. We therefore selected eight dental patients and six vascular patients and spoke to them via the telephone. Every patient that we contacted was happy to share their experience of the service with us and the majority of those we spoke with were complimentary about the service provided to them. One person told us, “The doctor who treated me was very professional and extremely detailed in the way they informed me about the procedure. I was entirely sure that I knew what I was consenting to.” Another person said, “Staff are superb and have put me at ease. Staff took the time to reassure me and the treatment went very well.” One person told us that they had experienced some discomfort during their procedure, but they thought this was to be expected. Another person thought that they would be required to pay for follow-up appointments and so had not accessed the aftercare they were entitled to.

The clinic had not issued a patient satisfaction survey in 2012 and so we were unable to assess any comments made. We reviewed records of patient consent and saw that the consent policy was adhered to. We found some gaps in medical records and we were told that many of the records for vascular patients were not available on site for us to view. We looked at staff records and found that criminal bureau checks for some staff were not stored on site. We found the premises to be clean.

On the day of our visit there were no patients available to talk to. We asked the provider to select a random sample of patients and ask them if they would be happy for us to contact them to gain their views on the service and the treatment they had received. We did contact them by telephone and they were happy to tell us that they found the service very caring, professional and would have no hesitation in recommending to friends. One person said that although there had been an ongoing complication following her surgery the service was reviewing and monitoring her progress regularly.

We also reviewed recent client satisfaction reviews and sampled a selection of cards and plaudits displayed in the reception area. We found that these included comments such as “I felt so safe in your hands” and “what impressed me most was the team spirit and their unobtrusive efficiency and quiet confidence”.

One patient commented “I have now put my face on Face Book as a real testimony to your skills”. Another said “thank you for transforming my feet, I am so very grateful”.

This practice was previously known and registered as Clinic Nine. The old name Clinic Nine is no longer registered with CQC.

For the purpose of this report we refer to the provider as Paris P Ltd and Smile Implant Clinics as this is the registered name at this location at the time of publishing this report.

We carried out an announced follow- up inspection on 03 October 2016 and an announced inspection on the 27 February 2017 at Smile Implant Clinics. Following previous inspections the provider had received two warning notices and a requirement notice for the breaches of regulation.

You can read the previous inspection reports from our website at www.cqc.org.uk by selecting the 'all reports' link for Smile Implant Clinics.

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 did not assess this domain at this inspection

Are services caring?

We did not assess this domain at this inspection

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

Background

CQC inspected the practice on 31 March 2016 and asked the provider to make improvements regarding Regulation 15 HSCA (RA) Regulations 2014 Premises and equipment, Regulation 12 HSCA (RA) Regulations 2014 Safe care and treatment, and Regulation 17 HSCA (RA) Regulations 2014 Good governance.

We checked these breaches as part of the follow-up inspection on 03 October 2016 and 27 February 2017.

Smile Implant Clinics provides private dental treatment and facial aesthetics from their clinic in Hove, near Brighton.

The majority of the dental treatment provided is implants with some general dentistry. The practice mostly provides treatment for adults but has a very small number of patients that are children.

Practice staffing consisted of the principal dentist who is also the owner and registered manager, a practice manager, a dental nurse and a receptionist.

The principal dentist, Dr Mehdi Pourani 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.

The practice opening hours are 9.00am to 6.00pm Monday to Friday.