We carried out an announced comprehensive inspection on 11 December 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 not providing safe care in accordance with the relevant regulations.

Are services effective?

We found that this practice was not 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 not 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 Harley Street Advanced Dental Centre is located in the London Borough of Westminster and provides private dental services.

The staff structure of the practice consists of a dentist, a practice manager, an assistant practice manager and a dental nurse.

The practice premises consists of two treatment rooms (one was not in use), a decontamination room and a waiting area.

The provider is registered with the Care Quality Commission (CQC) as an individual. Like registered providers, they are ‘registered persons’. 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.

Before the inspection we sent Care Quality Commission (CQC) comment cards to the practice for patients to complete to tell us about their experience of the practice. Sixteen patients provided feedback about the service. They provided a positive view of the services the practice provides. Patients commented that the quality of care was good.

Our key findings were:

• The practice had suitable processes around reporting and discussion of incidents.
• Staff were trained and there was appropriate equipment to respond to medical emergencies.
• Patients told us that staff were caring and treated them with dignity and respect.
• There was equipment for staff to undertake their duties but there was limited evidence of regular maintenance of equipment such as that used for decontamination of used instruments and for radiography.
• There was lack of appropriate systems in place to safeguard patients.
• The provider had not undertaken risk assessments to assess risk of fire, Legionella, health and safety or radiation.
• An appropriate complaints system had not been set up.
• Appropriate governance arrangements were not in place and there was lack of a clear vision for the smooth running of the practice.
• The practice policies were generic and not individualised to the practice.
• Clinical audits were not being undertaken appropriately and were not contributing to improvements in quality of care delivery.
• Staff were not receiving suitable training as recommended by the General Dental Council.

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

• Ensure an effective system is established to assess, monitor and mitigate the various risks arising from undertaking of the regulated activities.
• Ensure audits of various aspects of the service, such as radiography, infection control and dental care records are undertaken at regular intervals to help improve the quality of service. The practice should also check all audits have documented learning points and the resulting improvements can be demonstrated.
• Ensure that the practice has and implements, robust procedures and processes that make sure that people are protected from abuse.
• Ensure that the registered person establishes and operates effectively an accessible system for identifying, receiving, recording, handling and responding to complaints by service users.
• Ensure the training, learning and development needs of individual staff members are reviewed at appropriate intervals and an effective process is established for the on-going assessment and supervision of all staff.

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

• Review recruitment procedures to ensure accurate, complete and detailed records are maintained for all staff.
• Review the practice’s infection control procedures and protocols 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.’
• Review the availability of equipment 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.
• 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.
• Review the protocols and procedures for use of X-ray equipment giving due regard to Guidance Notes for Dental Practitioners on the Safe Use of X-ray Equipment.
• Review the practice's policy and the storage of products identified under Control of Substances Hazardous to Health (COSHH) 2002 Regulations to ensure they are stored securely .
• Review the practice protocols and adopt an individual risk based approach to clinical decisions such as patient recalls and wisdom teeth removal giving due regard to National Institute for Health and Care Excellence (NICE) guidelines.

Information about the services provided and the costs of treatments were available via the practice's website and leaflets on the premises. One person described the staff's attitude as "professional", whilst another described staff as "nice and helpful". People were treated in private and with a dental nurse present.

People told us that they were "satisfied" with the quality of the care they received and were given written plans of their treatment. Follow up appointments were made as appropriate.

The environment was clean and tidy on the day of the inspection and people who use the service told us that practice was always clean. There were appropriate arrangements for reprocessing used instruments.

Staff had undertaken training including basic life support and handling medical emergencies. The dental nurse worked under the supervision of the dentist.

Satisfaction surveys were carried out and they were acted on. For example, following a suggestion from a person, the provider extended the time for appointments. Clinical audits were carried out, for example on X-rays and the examination procedure. Areas for improvement were identified as appropriate.