We carried out this desk based follow up inspection on 27 June 2017 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We carried out an announced comprehensive inspection at the Chiswick Street Dental surgery on 7 December 2016 and at this time a breach of a legal requirement was found. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for The Chiswick Street Dental Practice on our website at cqc.org.uk

After the comprehensive inspection the practice wrote to us and told us that they would take action to meet the following legal requirements set out under the Health and Social Care Act (HSCA) 2008: Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 Safe Care and treatment; Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, Good Governance and Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 Fit and proper persons employed.

The practice was contacted and a request was made for them to submit evidence to demonstrate that they had made the necessary improvements and were now meeting the regulation identified as being breached at the last inspection. The practice’s action plan and a range of information was submitted by the practice and reviewed by a CQC inspector.

Our findings were:

Are services safe?

We found that this practice was now providing safe in accordance with the relevant regulations. The improvements needed had been made.

Are services well-led?

We found that this practice was now providing well-led care in accordance with the relevant regulations. The improvements needed had been made.

Background

Established in 2011, The Chiswick Street Dental practice is located in a grade 2 listed building and provides treatment to patients of all ages who fund their own care. There are two treatment rooms, a decontamination room for sterilising dental instruments, a staff room/kitchen and a general office. Access for wheelchair users or pushchairs is possible from a side ground floor entrance. There is a spacious reception and a waiting area on both floors of the premises.

The practice is open Monday, Tuesday, Thursday and Friday 08.30 -17.30 and Saturdays from 9.00 – 12.30. The practice is closed on a Wednesday.

The dental team is comprised of the principal dentist, three dental nurses, two part-time dental hygienists and one receptionist. There is no designated practice manager.

The practice provides general dentistry.

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.

Our key findings were:

• The legionella risk assessment had been reviewed and learning actions had been completed. The practice now checked and recorded monthly water temperatures to identify if there may be an increased risk of legionella.
• Staff had completed a GDC study day which included decontamination processes. We were sent confirmation to show the lead nurse was booked on to a lead decontamination course.
• The practice had completed an infection control and prevention audit using a recognised tool. They attained an overall score of 93%.
• Copies of test certificates for the autoclave were available and validation tests were now in place to ensure that the equipment was working properly.
• All clinical waste was removed correctly supported by a waste removal contract.
• X-ray audits had been undertaken and learning outcomes had been identified. Staff had undertaken a course on radiography.
• An AED has been purchased for the use in medical emergencies and staff had been trained on its use.
• The practice has now subscribed to receive MHRA updates.
• Recruitment protocols had been updated and personal files amended to ensure information stored was in line with regulation.

We carried out an announced comprehensive inspection on 7 December 2016 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 not providing safe care in accordance with the relevant regulations. The impact of our concerns, in terms of the safety of clinical care, is minor for patients using the service. Once the shortcomings have been put right the likelihood of them occurring in the future is low.

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

Established in 2011, The Chiswick Street Dental practice is located in a grade 2 listed building and provides treatment to patients of all ages on private dental payment packages. There are two treatment rooms, a decontamination room for sterilising dental instruments, a staff room/kitchen and a general office. Access for wheelchair users or pushchairs is possible from a side ground floor entrance. There is a spacious reception and a waiting area on both floors of the premises.

The practice is open Monday, Tuesday, Thursday and Friday 08.30 -17.30 and Saturdays from 9.00 – 12.30. The practice is closed on a Wednesday.

The dental team is comprised of the principal dentist, three dental nurses, two part-time dental hygienists and one receptionist. There is no designated practice manager. The principal dentist acted as the CQC lead and was willing to engage with the inspection team.

The practice provides general dentistry.

The principal dentist is registered with the Care Quality Commission (CQC) as an individual registered person. 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 reviewed 50 CQC comment cards on the day of our visit; patients were extremely positive about the staff and standard of care provided by the practice. Patients commented they felt involved in all aspects of their care and found the staff to be helpful, respectful, friendly and were treated in a clean and tidy environment.

Our key findings were:

• The practice was well organised, visibly clean and free from clutter.
• An Infection prevention and control policy was in place.
• The practice had systems for recording incidents and accidents.
• Practice meetings were used for shared learning.
• The practice had a child safeguarding policy and staff were aware on how to escalate safeguarding issues for children should the need arise. There was limited information regarding the protection of vulnerable adults.
• Staff received annual medical emergency training.
• Dental professionals provided treatment in accordance with current professional guidelines.
• Patient feedback was not regularly sought and reflected upon.
• Patients could access urgent care when required.
• Dental professionals were maintaining their continued professional development (CPD) in accordance with their professional registration.
• Complaints were dealt with in an efficient and positive manner.
• The practice was actively involved in promoting oral health.

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

• 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 gypsum waste received at the surgery is segregated and disposed of in accordance with relevant regulations giving due regard to guidance issued in the Health Technical Memorandum 07-01 (HTM 07-01).
• Ensure audits of various aspects of the service, such as radiography are undertaken at regular intervals to help improve the quality of service. Practice should also ensure all audits have documented learning points and the resulting improvements can be demonstrated.
• Ensure the practice updates their Legionella risk assessment and implements the required actions 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 by ensuring, where reasonable practicable, the required specified information in respect of persons employed by the practice is held.

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

• Review the training, learning and development needs of individual staff members and have an effective process established for the on-going assessment and supervision of all staff.
• Review why the practice did not receive alerts from the Medicines and Healthcare products Regulatory Agency (MHRA).
• Review the staff’s understanding of the principles of best interest decisions as highlighted in the Mental Capacity Act 2005(MCA).
• Review the availability of an AED to manage medical emergencies giving due regard to guidelines issued by the British National Formulary, the Resuscitation Council (UK), and the General Dental Council (GDC) standards for the dental team.

We spoke with people who used the service. They told us that they were satisfied with the care and treatment they received. One person said that "From the minute you walk in they are really friendly." and added "I've booked an appointment so I'm coming back!"

We found that before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. People experienced care, treatment and support that met their needs and were cared for in a clean, hygienic environment. Staff were supported to deliver care and treatment safely and to an appropriate standard.The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others.