We carried out an announced comprehensive inspection of this service on 11 February 2016 as part of our regulatory functions where two breaches of legal requirements were found. After the comprehensive inspection, the practice wrote to us to say what they would do to meet the legal requirements in relation to the breach.

We followed up on our inspection of 11 February 2016 to check that the practice had followed their plan and to confirm that they now met the legal requirements. This report only covers our findings in relation to those requirements. We have not revisited the Trinity Dental Care as part of this review because Trinity Dental Care were able to demonstrate that they were meeting the standards without the need for a visit. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Trinity Dental Care on our website at www.cqc.org.uk.

We carried out an announced comprehensive inspection on 11 February 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 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 not 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

Trinity Dental Care is located in the London Borough of Hackney and provides National Health Service (NHS) and private dental treatment to both adults and children. The premises are on the ground and first floor. The practice consists of two treatment rooms and a reception area. The premises are wheelchair accessible but did not have have facilities for wheelchair users such as a disabled toilet. The practice is open Monday to Thursday 9:00am – 6:00pm and Friday 9:00 – 5:00.

The practice staff consists of the principal dentist, one associate dentist, one dental nurse and a receptionist. The principal dentist is the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. 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.

The inspection took place over one day and was carried out by a CQC inspector and a dental specialist advisor.

We received feedback from 40 patients. Patients were positive about the service. They were complimentary about the friendly and caring attitude of the staff.

Our key findings were:

• Patients’ needs were assessed and care was planned in line with current guidance such as from the National Institute for Health and Care Excellence (NICE).

• Patients were involved in their care and treatment planning so they could make informed decisions.

• The practice had effective safeguarding processes in place and staff understood their responsibilities for safeguarding adults and child protection.

• The appointment system met the needs of patients and waiting times were kept to a minimum.

• Patients indicated that they found the team to be efficient, professional, caring and reassuring.

• Risk assessments and audits were carried out but it was not clear how the findings were used to drive improvement.

• The practice did not carry out a comprehensive risk assessment around the safe use, handling and Control of Substances Hazardous to Health, 2002 Regulations (COSHH)

• Pre-employment checks, such as Disclosure and Barring Service checks and references,had not been carried out for new members of staff

• One of the treatment rooms did not have a door which would be closed during treatment so there was the potential to breach patient confidentiality.

• We did not see evidence of portable appliance testing (PAT) and pressure vessel checks.

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

• Ensure that the equipment used by the service provider for providing care or treatment to a service user is safe for such use and is used in a safe way.

• Ensure the practice establishes an effective system to assess, monitor and mitigate the various risks arising from undertaking of the regulated activities.

• Ensure necessary employment checks are in place and the required information in respect of persons employed by the practice is held securely.

• Ensure privacy of the service users is maintained at all times and discussions about care, treatment and support only take place where they cannot be overheard.

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

• Review availability of equipment to manage medical emergencies giving due regard to guidelines issued by the Resuscitation Council (UK), and the General Dental Council (GDC) standards for the dental team.
• Review the current Legionella risk assessment and implement the required actions including the monitoring and recording of water temperatures, giving due regard to the 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 its audit protocols to ensure that where appropriate audits have documented learning points and the resulting improvements can be demonstrated.

This visit was a follow up to our inspections on the 26 August and 18 September 2014. At those inspections, we found that the practice was not compliant with the requirements of Regulation 9 (1) (b) (ii) and (iii) and Regulation 12 (2) (c) (ii) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

We had found that the provider was not meeting the essential standards relating to the care and welfare of people who used the service and to cleanliness and infection control. The provider was not acting in accordance with current guidance relating to regular inspections of the intra-oral x-ray equipment at the practice, the disposal of hazardous waste, and the carrying out of regular infection control audits.

We served three Warning Notices, which required the provider to comply with the regulations by 26 January 2015. However, a system error meant this was not reflected in our report of the inspections, published on 5 March 2015. We made this visit on 16 March 2015 to check that the provider had taken appropriate and sufficient action to comply with the notices and regulations. We found that the provider had taken appropriate action to comply with the notices, but we identified issues relating to the provider's records that require further action.

We spoke to two people who used the service and one was complimentary about the practice. They commented, "I have always received a good quick service and the staff are nice." The other said, "the practice is nothing spectacular but it's not too dreadful." They both felt that they were well informed about the choices, the cost and possible outcomes of their treatment.

We saw that there were some difficulties in terms of the organisation of the practice. Not all the necessary records were available for inspection as we were told that some were held at the sister practice, and that some records were lost following a flood at the other practice. Staff we spoke to had been with the practice for a considerable length of time which enabled the team to know the users of the service well.

We carried out this inspection to follow up non-compliance with two regulations we identified at our previous inspection visits on 8 October 2013 and 11 October 2013. Concerns were identified with how the provider maintained the hygiene of the premises and some staff had not completed child protection training.

At our inspection visits on 26 August 2014 and 18 September 2014 we found that the provider was not meeting the essential standards, for the care and welfare of people who used the service and cleanliness and infection control. We found concerns about the safety of the intra-oral x-ray machines as the provider could not demonstrate that the equipment had been serviced in accordance with the manufacturer’s guidance. Expired dental materials were found in one of the clinical treatment rooms.

The provider failed to follow guidance as set out in the Department of Health publication ‘Health Technical Memorandum-Decontamination in primary care dental practices (HTM 01 – 05)’. Mirrors and probes were not kept at the practice as recommended in the guidance.

The provider was meeting the essential standard for safeguarding people who use services from abuse. Training records we saw demonstrated that all staff had completed recent child protection training.