We undertook a follow up desk-based inspection of Surrey Docks Dental Practice on 12 March 2019. 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.

We undertook a comprehensive inspection of Surrey Docks Dental Practice on 22 November 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 and was in breach of regulations 17 Good governance and regulation 19: Fit and proper persons employed 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 Surrey Docks Health Centre on our website www.cqc.org.uk.

• Is it well-led?

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 areas where improvement was required.

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 breaches we found at our inspection on 22 November 2018.

Background

Surrey Docks Dental Practice is in the London Borough of Southwark and provides NHS and private treatment to patients of all ages.

There is level access for people who use wheelchairs and those with pushchairs.

The dental clinical team includes a principal dentist, three associate dentists, a dental hygienist, and four qualified dental nurses. The clinical team is supported by three receptionists and a practice manager. The practice has four 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 desk-based inspection we spoke with the practice manager and the receptionist. We checked practice policies and procedures and other records about how the service is managed.

The practice is open at the following times:

Monday: 8.30am to 8pm

Tuesday and Thursday: 8.30am to 6pm

Wednesday: 9am to 7pm

Friday: 8.30am to 5pm

Saturday: 9am to 3pm

Appointments are not available between 1pm to 2pm Monday to Friday.

Our key findings were:

• The practice infection control procedures were in line with published guidance. Staff undertook appropriate infection prevention and control training and audits were carried out to monitor infection control procedures.
• There were suitable systems in place to deal with medical emergencies. The recommended life-saving equipment and medicines were available and staff had completed training in medical emergencies.
• The practice had made improvements to ensure risks were suitably identified, assessed, monitored and mitigated. These related to having effective processes for the management of materials and equipment, staff recruitment, immunisation, appraisal and training.
• The practice had made improvements to their safeguarding processes and staff had up to date training for safeguarding adults and children.
• Improvements had been made to the practice staff recruitment procedures and the appropriate and essential checks were carried out when employing new staff.
• There was effective leadership, and improvements had been made to the arrangements for monitoring the quality and safety of the services provided.
• The arrangements for assessing and minimising risks associated with lone working had been reviewed and improved.

We carried out this announced inspection on 22 November 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

Surrey Docks Dental Practice is in the London Borough of Southwark and provides NHS and private treatment to patients of all ages.

There is level access for people who use wheelchairs and those with pushchairs.

The dental clinical team includes a principal dentist, three associate dentists, a dental hygienist, and four qualified dental nurses. The clinical team is supported by three receptionists and a practice manager. The practice has four 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 obtained feedback from two patients.

During the inspection we spoke with two dentists, two dental nurses, and a receptionist. We checked practice policies and procedures and other records about how the service is managed.

The practice is open at the following times:

Monday: 8.30am to 8pm

Tuesday and Thursday: 8.30am to 6pm

Wednesday: 9am to 7pm

Friday: 8.30am to 5pm

Saturday: 9am to 3pm

Appointments are not available between 1pm to 2pm Monday to Friday.

Our key findings were:

• The practice appeared clean and well maintained.
• The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• 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 and worked well as a team.
• The practice asked patients for feedback about the services they provided.
• The practice dealt with complaints positively and efficiently.
• The practice had suitable information governance arrangements.
• The provider had medicines and equipment on site for managing medical emergencies. Some recommended emergency equipment was not available, but was ordered shortly after the inspection.
• The practice had infection control procedures. Improvements could be made to ensure the audits were undertaken six-monthly as per current guidance.
• Improvements were required to establish thorough staff recruitment procedures. The provider began to address this immediately after the inspection.
• Improvements could be made to ensure dental dams were used for root canal treatments and in cases where not used it was risk assessed and suitably recorded in the dental care records.
• Improvements were required to ensure the practice had effective systems to help them assess, monitor and manage the risks relating to undertaking of the regulated activities.

We discussed our findings with the principal dentist and the practice manager. They showed a commitment to addressing our concerns, and in making the necessary improvements. 

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 recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed, and ensure specified information is available regarding each person employed.

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

• Review the practice's protocols for completion of dental care records considering guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.
• Review the practice’s protocols for referral of patients and ensure all referrals are monitored suitably.
• Review the security of prescription pads in the practice and ensure there are suitable systems in place to track and monitor their use.
• 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.

We carried out an announced comprehensive inspection on 3 September 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 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 providing well-led care in accordance with the relevant regulations

Surrey Docks Dental Practice is located in the London Borough of Southwark and provides a mix of NHS dental services and services to private patients. The demographics of the practice were mixed, serving patients from a range of social and ethnic backgrounds. The practice is open Monday to Saturday with a range of opening times including evening appointments. The practice facilities include three consultation rooms, reception and waiting area, decontamination room, staff room and administration office. The premises are wheelchair accessible and have facilities for wheelchair users, including an accessible toilet.

We did not receive any completed Care Quality Commission comment cards; however we spoke with three patients during the inspection. They were positive about the service and gave good feedback. They told us that staff were friendly and polite and always treated them with respect. Information was given to them and if they did not understand anything staff always explained things well.

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.
• There were appropriate equipment and access to emergency drugs to enable the practice to respond to medical emergencies. Staff knew where equipment was stored.
• All clinical staff were up to date with their continuing professional development.
• There was appropriate equipment for staff to undertake their duties, and equipment was maintained appropriately.
• Appropriate governance arrangements were in place to facilitate the smooth running of the service, including a programme of audits for continuous improvements.

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

Review staff awareness of the requirements of the Mental Capacity Act (MCA) 2005 and ensure all staff are aware of their responsibilities under the Act as it relates to their role.