We carried out a focused inspection of The Heathway Dental Surgery on 14 March 2018.

The inspection was led by a CQC inspector who had remote access to a specialist dental adviser.

We carried out the inspection to follow up concerns we originally identified during a comprehensive inspection at this practice on 19 October 2017 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions.

At a comprehensive inspection we always ask the following five questions to get to the heart of patients’ experiences of care and treatment:

• Is it safe?
• Is it effective?
• Is it caring?
• Is it responsive to people’s needs?
• Is it well-led?

When one or more of the five questions is 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.

At the previous comprehensive inspection 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 The Heathway Dental Surgery on our website www.cqc.org.uk.

We also reviewed the key questions of safe and effective as we had made recommendations for the provider relating to these key questions. We noted that improvements had been made.

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 to put right the shortfalls and deal with the regulatory breach we found at our inspection on 19 October 2017.

We carried out this announced inspection on 19 October 2017 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.

We told the NHS England area team that we were inspecting the practice. They did not provide any information.

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 Heathway Dental Surgery is located in Dagenham, in the London Borough of Barking and Dagenham. The practice provides NHS and private dental treatments to patients of all ages.

The practice is located on the first floor of a purpose adapted residential premises. The practice has two treatment rooms. The practice is conveniently located close to public transport links.

The dental team includes three associate dentists, two qualified dental nurses and two trainee dental nurses. The dental nurses cover receptionist duties.

The practice is owned by an individual who does not work at the practice. 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.

We received feedback from 29 patients via CQC comment cards and speaking with patients. This information gave us a positive view of the practice.

During the inspection we spoke the two associate dentists, one dental nurse and two trainee dental nurses. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open between 9am and 6pm on Mondays to Fridays. Private appointments are available by appointment on Saturdays.

The practice is closed between 1pm and 2pm for lunch.

Our key findings were:

• The practice was clean and well maintained.
• The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• The practice had thorough staff recruitment procedures.
• 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 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. However there were limited systems for quality assurance of these procedures in line with published guidance.
• Staff knew how to deal with emergencies. However some items of life-saving equipment as per current national guidelines were not available or were past their expiry date. The practice responded immediately to procure these pieces of equipment.
• The practice had some systems to help them assess and manage risk. However these were not always consistent or in line with current guidance and legislation.
• The practice leadership systems were not clear or effective.

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.

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 protocols for handling needles and other dental sharps taking into account the European Council Directive 2010/32/EU (the Sharps Directive) and other published guidance.
• Review the protocols and procedures for use of X-ray equipment taking into account Guidance Notes for Dental Practitioners on the Safe Use of X-ray Equipment.
• Review the training, learning and development needs of individual staff members at appropriate intervals and ensure an effective process is established for the on-going assessment, supervision and appraisal of all staff.

Following our inspection of the dental practice we were provided with some updated documents in relation to servicing equipment and some training records. We were also provided with details of the changes which the provider was implementing as a result of our findings.

We will review these changes when we next inspect the practice.

People we spoke with were happy with the service provided. One person told us “my mum and dad come here and so do all my children. They are all polite and friendly here”. Another person told us they had come for some emergency treatment last week. We were told “I was seen very quickly, I can’t fault it”.

We found that treatment options and costs were clearly displayed and explained to people. There were arrangements in place to deal with foreseeable emergencies and there were effective systems in place to reduce the risk and spread of infection. People’s personal records were accurate and kept securely.