We carried out a follow- up inspection on 01 September 2016 at Smiles 4 U Dental Care.

We had undertaken an announced comprehensive inspection of this service on 24 November 2015 as part of our regulatory functions where 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.

We revisited Smiles 4 U Dental Care as part of this review and checked whether they had followed their action plan and to confirm that they now met the legal requirements.

We reviewed the practice against one of the five questions we ask about services: is the service well-led?

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

We carried out an announced comprehensive inspection on 24 November 2015 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 providing safe care in accordance with the relevant.

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

Smiles 4 U is located in the London Borough of Haringey and provides NHS and private treatment to both adults and children. The premises is on the ground floor and consists of three surgeries, a reception area and a dedicated decontamination room. The premises are wheelchair accessible and have facilities for wheelchair users, including an accessible toilet . The demographic of the practice is mixed and serves patients from different social and ethnic backgrounds. The practice is open Monday to Friday 9:30am – 6:00pm and Saturday 9:30am – 2:00pm.

The staff consists of the principal dentist, four associate dentists, three trainee dental nurses, one dental hygienist and a practice manager. The principal dentist is registered with the Care Quality Commission (CQC) as an individual. 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 received 26 Care Quality Commission (CQC) comment cards completed by patients. Patients who completed the comment cards 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:

• Patients’ needs were assessed and care was planned in line with current guidance.
• Patients were involved in their care and treatment planning so they could make informed decisions.
• There were effective processes in place to reduce and minimise the risk and spread of infection; however improvements were required in relation to following current infection control guidance.

• Staff had been trained to handle emergencies, and appropriate medicines and life-saving equipment were readily available. Staff knew where the equipment was stored

• There were systems in place to check equipment had been serviced regularly, including the dental air compressor, autoclaves, oxygen cylinder and the X-ray equipment.

• We found the dentists regularly assessed each patient’s gum health and took X-rays at appropriate intervals.

• Patients were treated with dignity and respect and confidentiality was maintained.

• The appointment system met the needs of patients and waiting times were kept to a minimum.

• There was an effective complaints system and the practice was open and transparent with patients if a mistake had been made.
• At our visit we observed staff were kind, caring and professional.
• Suitable checks had not been undertaken before employing staff.
• Governance arrangements were in place for the running of the practice; however the practice did not have a structured plan in place to assess various risks arising from undertaking the regulated activities and to effectively audit quality and safety.
• The practice had not carried out an infection control or X-ray audit in the last 12 months.
• No formal appraisals had been carried out with staff to discuss their role and identify additional training needs.

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

• 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 and effective system is established to assess, monitor and mitigate the various risks arising from undertaking of the regulated activities.

• 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 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.

There were areas where the provider could make improvements and should:

• Review the protocols and procedures for use of X-ray equipment giving due regard to Guidance Notes for Dental Practitioners on the Safe Use of X-ray Equipment.

One inspector visited the practice on two separate occasions; on the afternoon of 31st January 2012 and evening of 6th February 2012. We spoke with patients and staff and examined a range of records.

Patients we spoke to told us that their treatment and its costs were clearly explained to them, and they felt that their privacy and dignity were promoted during consultations and treatment.

Clear records of consultations and treatment were maintained for each patient. For NHS patients treatment plans were available that had been signed by patients to indicate their consent. Similar treatment plans were not available for patients who funded their treatment through monthly pre paid insurance schemes. We did not find completed medical histories in any of the patient notes we looked at.

The provider has appropriate equipment and facilities to ensure that used instruments are disinfected and sterilised before use. However, we were concerned that inconsistent practise with regard to the packaging and date labelling of instruments in the various treatment rooms in the practice could compromise the safety and welfare of patients. Staff shortages on one of the days we visited and unfamiliarity by some staff with key decontamination guidance could also pose potential risks to patients. We were also concerned that key staff involved in the disinfection and sterilisation of instruments had not received recent infection control training.

We found that the provider operated in suitable premises. During our visit to the practice redecoration works were taking place. However, we formed the view that some additional minor maintenance works were required to promote patient safety and wellbeing. We were also concerned that the current layout of the premises meant that the decontamination room doubled as a kitchen, with clinical materials and food being stored in the same fridge.

Patients health needs were met by appropriately qualified staff. However, we found that for some staff appropriate pre employment checks had not being completed out by the provider.

We found that the provider had obtained appropriate insurance cover and that suitable contracts were in place to maintain equipment and machinery used in the practice. However, we found that some key infection control records that ensure the safety and well being of patients were not being maintained.

This inspection was carried out to check that improvements had been made since the previous inspection. We visited over two days and spoke to a dentist, a dental nurse and a receptionist and checked the records. We did not speak to any patients however we checked the feedback which had been provided to the surgery which was generally positive.

We saw that records of consultations and treatment were maintained for each patient. The treatment plans we saw were signed by patients and these included their up to date medical histories to ensure that dental treatment could be given safely.

The provider had the appropriate equipment and facilities to ensure that used instruments were disinfected and sterilised before their use. We saw the decontamination process and found it to be satisfactory. We found that all members of staff had completed infection control training. We saw that there had been a recent infection control audit and that there were regular checks to ensure that all the treatment areas and the practice was clean and hygienic.

The practice been refurbished since the last inspection and the premises were suitable for their purpose. One member of staff had been employed since the last inspection and appropriate pre-employment checks had been completed.