We undertook a follow up inspection of St Helier Dental Surgery on 7 December 2018. This inspection was carried out to review in detail the actions taken by the registered provider to improve the quality of care and to confirm that the practice was now meeting legal requirements.

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

We undertook a comprehensive inspection of St Helier Dental Surgery on 15 June 2018 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We found the registered provider was not providing well led care in accordance with the relevant regulations 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 St Helier Dental Surgery on our website www.cqc.org.uk.

When one or more of the five questions are not met we require the service to make improvements and send us an action plan. We then inspect again after a reasonable interval, focusing on the area where improvement was required.

As part of this inspection we asked:

• Is it well-led?

Our findings were:

Are services well-led?

We found this practice was providing well-led care in accordance with the relevant regulations.

The provider had made improvements in relation to the regulatory breach we found at our inspection on 15 June 2018.

We found this practice was providing well-led care in accordance with the relevant regulations.

Background

St Helier is in the London borough of Merton and provides NHS and private treatment to adults and children.

There is level access for people who use wheelchairs and those with pushchairs. Unrestricted car parking spaces are available in local surrounding roads.

The dental team includes five dentists, five dental nurses (two of which also provide reception duties), two dental hygienists and two receptionists. The practice has three treatment rooms.

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.

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

Our key findings were:

• The provider had established effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

• Systems were in place to demonstrate how they used learning from incidents and complaints to improve the service.

• Systems were in place to monitor staff training.

• Policies and procedures were up to date

• An up to date sharps risk assessment was in place.

• All staff had completed recent medical emergencies training.

• Systems were in place to obtain and store documentation relating to staff recruitment.

• The provider had reviewed their responsibilities to consider the needs of patients with disabilities.

• The safeguarding policy was up to date and details of the local authority were readily available to staff.

We carried out this announced inspection on 15 June 2018 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 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 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

St Helier Dental Surgery is in Morden and provides NHS and private treatment to adults and children.

There is level access for people who use wheelchairs and those with pushchairs. Unrestricted car parking spaces are available in local surrounding roads.

The dental team includes five dentists, five dental nurses (two of which also performed reception duties), two dental hygienists, two receptionists, one reception manager and an associate manager. The practice has three treatment rooms.

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 90 CQC comment cards filled in by patients.

During the inspection we spoke with two dentists, two dental nurses, one of the receptionists, the reception manager and the associate manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open: Monday, Tuesday, Thursday and Fridays from 9.00am to 6.00pm; Wednesdays 9.00am to 7.00pm and Saturdays 9.00am to 1.00pm

Our key findings were:

• The practice appeared clean and well maintained.
• The practice staff had infection control procedures which reflected published guidance.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available. Some staff had not completed medical emergencies training.
• The practice systems to help them manage risk required improvements.
• The practice staff had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children. Although, safeguarding policies we were given required updating.
• The practice had staff recruitment procedures. However, processes for maintaining records required improving.
• The clinical staff provided patients’ care and treatment in line with current guidelines.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• The practice was providing preventive care and supporting patients to ensure better oral health.
• The appointment system generally met patients’ needs.
• The practice did not have effective leadership and there was no culture for continuous improvement.
• Some staff felt involved and supported and worked well as a team.
• The practice asked staff and patients for feedback about the services they provided.
• The practice staff dealt with complaints positively and efficiently.
• The practice did not have suitable governance arrangements.

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.

Full details of the regulation/s the provider was/is not meeting are at the end of this report.

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

• Review the practice's responsibilities to take into account the needs of patients with disabilities and to comply with the requirements of the Equality Act 2010.