We undertook a follow up focused inspection of The Dentist Gallery on 26 April 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 who had remote access to a specialist dental adviser.

We undertook a comprehensive inspection of The Dentist Gallery on 16 October 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 18 – Staffing 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 The Dentist Gallery 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 breach we found at our inspection on 16 October 2018.

Background

The Dentist Gallery is in the London Borough of Westminster. The practice provides private general and cosmetic dental treatment to patients of all ages. The practice is situated close to public transport bus and train services.

The dental team includes the principal dentist, three associate dentists, and two trainee dental nurses. The clinical team are supported by a clinic coordinator / receptionist.

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,,

We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Mondays, Tuesdays, Thursdays and Fridays between 9am and 7pm.

Wednesdays between 10am and 7pm.

Saturdays between 9am and 2pm.

Sundays for emergency appointments.

Our key findings were:

• The practice infection control procedures had been reviewed and improved so that infection prevention and control audits were carried out in line with current guidance.

• There were arrangements to deal with medical emergencies. The recommended medicines and life-saving equipment were available and staff were trained in basic life support.

• The practice had systems to help them manage risk. Improvements had been made so that risks associated with fire safety and the use of dental sharps were regularly assessed and managed.

• The practice had suitable staff recruitment procedures.

• There were arrangements for monitoring and supporting staff to carry out their roles. Staff had access to appropriate training and there were arrangements in place to appraise staff performance/ and monitoring the quality and safety of the services provided.

• There were arrangements to monitor and improve quality in relation to dental radiography though a system of audits. The practice’s sharps procedures were in compliance with the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.

• The practice had reviewed the systems for assessing risks associated with the premises and equipment. We noted that risk assessments were reviewed and that action plans were in place where these assessments identified areas for improvement.

• Improvements had been made to the practice’s protocols for recording in the patients’ dental care records or elsewhere the reason for taking the X-ray and quality of the X-ray ensuringcompliance with the Ionising Radiation (Medical Exposure) Regulations (IRMER) 2017.

• Improvements had been made to the practice's protocols for completion of dental care records taking into account guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.

• The practice had reviewed its responsibilities to respond to the needs of patients with disability and the requirements of the Equality Act 2010..

• Improvements had been made to the arrangements to respond to the needs of patients with disability and the requirements of the Equality Act 2010.

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

Review the practice's policy and the storage of products identified under Control of Substances Hazardous to Health (COSHH) 2002 Regulations to ensure a risk assessment is undertaken and risks are identified and mitigated.

Review staff training to ensure that all dental staff who are assisting in conscious sedation have the appropriate training and skills to carry out the role taking into account guidelines published by The Intercollegiate Advisory Committee on Sedation in Dentistry in the document 'Standards for Conscious Sedation in the Provision of Dental Care 2015’.

We carried out this announced inspection on 16 October 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

The Dentist Gallery is in the London Borough of Westminster. The practice provides private general and cosmetic dental treatment to patients of all ages.

The practice is situated close to public transport bus and train services.

The dental team includes the principal dentist, three associate dentists, and two trainee dental nurses. The clinical team are supported by a clinic coordinator / receptionist.

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 received feedback from seven patients.

During the inspection we spoke with the principal dentist, one trainee dental nurse and the clinic coordinator / receptionist. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Mondays, Tuesdays, Thursdays and Fridays between 9am and 7pm.

Wednesdays between 10am and 7pm.

Saturdays between 9am and 2pm.

Sundays for emergency appointments.

Our key findings were:

• The practice appeared clean and well maintained.
• 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 met patients’ needs.
• The practice asked staff and patients for feedback about the services they provided.
• The practice dealt with complaints positively and efficiently.
• The practice had infection control procedures which reflected published guidance. Improvements were needed so that infection prevention and control audits were carried out in line with current guidance.
• Improvements were needed to the arrangements to deal with medical emergencies by ensuring that appropriate medicines and life-saving equipment were available and staff were trained.
• The practice had some systems to help them manage risk. Improvements were needed to ensure that risks were regularly assessed and managed. This specifically relates to fire safety and the use of dental sharps.
• The practice had safeguarding processes. Improvements were needed so that all staff had up to date training for safeguarding adults and children.
• The practice had staff recruitment procedures. Improvements were needed so that these were followed and all appropriate checks were carried out when employing new staff.
• Improvements were needed to the practice leadership so that it was effective. This relates specifically to the arrangements for monitoring and supporting staff to carry out their roles and monitoring the quality and safety of the services provided.
• Improvements were needed to ensure the practice had suitable information governance arrangements so that they reflected current requirements and legislation.

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 sufficient numbers of suitably qualified, competent, skilled and experienced persons are deployed to meet the fundamental standards of care and treatment

Full details of the regulations the provider was not meeting are at the end of this report.

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

• Review the practice’s sharps procedures and ensure the practice is in compliance with the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.
• Review the practice's policy and the storage of products identified under Control of Substances Hazardous to Health (COSHH) 2002 Regulations to ensure a risk assessment is undertaken and risks are identified and mitigated.
• Review the practice's environmental risk assessments and ensure that the necessary actions are implemented. This relates specifically to the practice fire risk assessment.
• Review staff training to ensure that dental staff who are assisting in conscious sedation have the appropriate training and skills to carry out the role taking into account guidelines published by The Intercollegiate Advisory Committee on Sedation in Dentistry in the document 'Standards for Conscious Sedation in the Provision of Dental Care 2015’.
• Review the practice’s protocols for recording in the patients’ dental care records or elsewhere the reason for taking the X-ray and quality of the X-ray ensuring compliance with the Ionising Radiation (Medical Exposure) Regulations (IRMER) 2000.
• Review the practice's protocols for completion of dental care records taking into account guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.
• Review its responsibilities to respond to the needs of patients with disability and the requirements of the Equality Act 2010.