We carried out this announced follow-up inspection on 22 October 2018. 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 1 May 2018 we found the registered provider was providing safe, effective, caring and responsive care in accordance with relevant regulations. We judged the practice was not providing 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 Lakeside Health Centre 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 22 October 2018 to check that they had followed their plan. We reviewed the key questions of well-led.

Our findings were:

Are services well-led?

We found that this practice was providing well-led care in accordance with the relevant regulations. They demonstrated they had addressed the shortfalls and regulatory breach we identified when we previously inspected their practice 1 May 2018. The provider had made improvements with regard to:

• Ensuring effective systems and processes were in place to ensure good governance in accordance with the fundamental standards of care.

We carried out this announced inspection on 1 May 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 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 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

Lakeside Health Centre is in Thamesmead, in the London Borough of Bexley. The practice provides NHS treatment to patients of all ages.

There is level access for people who use wheelchairs and those with pushchairs. There is parking available for patients on the premises.

The dental team includes two dentists, a qualified dental nurse, a trainee dental nurse, and a receptionist. The dental nurses also undertake receptionist duties. The practice has a treatment room on the first floor of the premises which is accessible via stairs and a lift.

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 obtained feedback from 55 patients.

During the inspection we spoke with the principal dentist and the dental nurses. We checked practice policies and procedures and other records about how the service was managed.

The practice is open at the following times:

Monday to Thursday: 9am to 1pm and 2pm to 5.30pm.

Friday: 9am to 1pm and 2pm to 4.30pm.

Our key findings were:

• The practice appeared clean and well maintained.
• 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 met patients’ needs.
• Staff felt involved and supported.
• The practice dealt with complaints positively and efficiently.
• Staff had received appraisals.
• Continuing professional development records were not available for some staff to show they had completed and updated key training.
• Recruitment checks such as employment histories, photographic identification and Disclosure and Barring Service checks were in place, though improvements could be made to obtain and record references suitably.
• Some staff we spoke with were not aware of how to use the oxygen cylinder in the event of a medical emergency.
• Staff we spoke with were not clear on the protocol for safe disposal of extracted teeth containing amalgam.
• The provider had not ensured a member of staff had adequate immunity against Hepatitis B infection.
• Medicines to manage medical emergencies were available but the provider did not have some life-saving equipment.
• The clinical staff did not record some key information regarding the use of rubber dam in patients’ dental care records.
• There was a lack of effective systems and processes to ensure good governance.

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.

There were areas in which 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.

Shortly after the inspection the practice sent us evidence demonstrating they had begun to take steps to make improvements. We will check improvements have been implemented, sustained and embedded when we carry out a follow-up inspection of the practice.

We spoke with nine people who used the service who told us they were treated with respect and the quality of care was excellent. One person said: “the dentist is exceptional and the staff are considerate, respectful and very professional”. Another person said: “The treatment I get is excellent, I have some serious health issues and the dentist always asks me for updates each time I visit”. People said that the dentists always consulted with them about proposed treatment including cost of treatment and asked for their written consent.

People told us their privacy and confidentiality was protected by the staff and dentists, and they were always spoken with in a respectful manner. People said that the dentist had always asked them for an update on their health at each visit and had included relevant information in their treatment plan. There was a dental plan for people, which was agreed before treatment, and the needs and safety of people with mobility support needs were considered so that they were safe and could access services.

The practice was clean and well maintained and all of the people we spoke with told us that the practice treatment rooms were very clean and the dentists’ practices were hygienic.

Staff were qualified and had appropriate training and supervision and were supported by the practice to update their training to do their job safely. Two staff we spoke with told us they were well supported by the practice to understand their responsibilities and with their personal development.