We carried out this announced focused inspection on 13 September 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 CQC inspector.

This followed an inspection on 26 April 2017 that had been carried out as part of our regulatory functions where breaches of legal requirements were found.

Our findings were:

Are services well-led?

We found that this practice was now providing well-led care in accordance with the relevant regulations.

We carried out this announced inspection on 26 April 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 CQC inspector who was supported by a specialist dental adviser. There was also remote support from the CQC medicines team.

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

Vitaleurope UK Limited is in Westminster and provides private treatment to adult patients. The main business of the practice is proving dental implants.

The dental team includes 12 dentists, three dental nurses, one dental hygienist and four receptionists. The practice has two treatment rooms.

The practice is owned by Vital Europe UK Ltd and as a condition of registration must have a person registered with the Care Quality Commission as the registered manager. Registered managers 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 registered manager at Vitaleurope UK Limited was the providers Managing Director.

On the day of inspection we collected 12 CQC comment cards filled in by patients and spoke with three other patients. This information gave us a positive view of the practice.

During the inspection we spoke with two dentists, two dental nurses, two receptionists, a practice manager and the managing director. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open 9.00 to 6.00pm Monday to Friday and 10.00 to 3.00pm on Saturday’s.

Our key findings were:

• The practice was clean and well maintained.
• The practice had infection control procedures which reflected published guidance.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• 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 had effective leadership. Staff felt involved and supported and worked well as a team.
• The practice had recorded some feedback from patients.
• The practice dealt with complaints positively and efficiently.

• The practice had some systems to help them manage risks and improvements were required.
• Not all practice staff we spoke with had a good understanding of safeguarding issues and not all staff had completed training in safeguarding of children and vulnerable adults.
• The practice lacked robust staff recruitment procedures.

We identified regulations the provider was not meeting. They must:

• Ensure systems are in place to assess, monitor and improve the quality of the service such as undertaking regular audits of various aspects of the service and ensuring that where appropriate audits have documented learning points and the resulting improvements can be demonstrated. Ensure the practice establishes an effective system to assess, monitor and mitigate the various risks arising from undertaking of the regulated activities.

• 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 to ensure necessary employment checks are in place for all staff and the required specified information in respect of persons employed by the practice is held.

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 and should:

• Review the practice’s arrangements for receiving and responding to patient safety alerts, recalls and rapid response reports issued from the Medicines and Healthcare products Regulatory Agency (MHRA) and through the Central Alerting System (CAS), as well as from other relevant bodies such as, Public Health England (PHE).

• Review staff training to ensure all staff are trained to an appropriate level for their role and are aware of their responsibilities as regards safeguarding of children and vulnerable adults.

• Review the systems for checking and monitoring equipment taking into account current national guidance and ensure that all equipment is well maintained.
• Review the practice’s responsibilities to respond to the needs of  patients with disability and the requirements of the Equality Act 2010 and ensure a Disability Discrimination Act audit is undertaken for the premises.   

Two people who use the service told us that staff gave them adequate information about their treatment and its costs. They said that they were given information packs and that the treatment process was "clearly explained". People were treated in private and with a dental nurse present.

The dentist told us that he always explained the treatment procedures to people and written copies of their treatment plans were routinely given to them. Investigations were carried out and follow up appointments arranged as necessary. One person described the service as "very good" and said that their treatment plan was explained "in detail".

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. Instruments were appropriately decontaminated and stored safely.

Staff had undertaken training including infection control, first aid and fire safety. One dentist told us that he attended relevant training on periodontology and dental implants recently. Dental nurses worked under supervision of dentists and were appraised on their performance on an annual basis.

Satisfaction surveys were carried out regularly. Analysis of the latest survey found that the majority of respondents were satisfied with their treatment. A clinical governance audit was carried out in 2010. A sensor had been installed to the X-ray room door. This meant that the door could not be opened whilst the X-ray machine was being operated.