We undertook a focused inspection of Waters Dental Practice on 3 October 2018. 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 was supported by a specialist dental adviser.

We undertook a comprehensive inspection of Waters Dental Practice on 29 November 2017 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 safe and well led care in accordance with the relevant regulations 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 Waters Dental Practice on our website www.cqc.org.uk.

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.

As part of this inspection we asked:

• Is it safe?

• Is it well-led?

Our findings were:

Are services safe?

We found this practice was providing safe care in accordance with the relevant regulations.

The provider had made improvements in relation to the regulatory breaches we found at our inspection on 29 November 2017.

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/es we found at our inspection on 29 November 2017.

Background

Waters Dental Practice is in Worcester Park and provides NHS and private treatment to adults and children.

There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces are available in surrounding roads.

The dental team includes one dentist, one dental nurse, and a receptionist. The practice has one treatment room.

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 dentist, the dental nurses and the receptionist. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Our key findings were:

• The provider had arrangements in place to receive and respond to patient safety alerts from Medicines and Healthcare products Regulatory Agency (MHRA).

• The provider had reviewed systems for checking and monitoring equipment and servicing of equipment. Logs were in place to check equipment and they had all been serviced in line with manufacturers guidelines

• Dental care records we reviewed demonstrated that the dentist was taking into account guidance provided by the Faculty of General Dental Practice with regard to clinical examination and record keeping.

• The practice had processes in place to identify interpreters if required for patients.

• The practice had reviewed systems in place for training. Staff had access to and had completed training in line with expectations

• Staff were aware of their responsibilities under the Duty of Candour.

We carried out this announced inspection on 29 November 17 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.

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 not 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

Waters Dental Practice is in Worcester Park and provides NHS and private treatment to patients of all ages.

There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces are available in surrounding roads.

The dental team includes a dentist, a dental nurse and a receptionist. The practice is set out over one level and has a waiting area and a surgery, decontamination room and a patient toilet.

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 collected 27 CQC comment cards filled in by patients. This information gave us a positive view of the practice.

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

The practice is open: Monday to Wednesday 9.00-5.30pm; Thursday and Friday 9.00-1.00pm. The practice closes for lunch from 1.00pm to 2.30pm Monday to Wednesdays.

Our key findings were:

• The practice was clean and well maintained.
• The practice had staff recruitment procedures.
• Staff treated patients with dignity and respect however we observed examples of where privacy was not maintained because the door of the treatment room was left open during treatment procedures.
• The appointment system met patients’ needs.
• Staff felt involved and supported and worked well as a team.
• The practice asked patients for feedback about the services they provided.
• The practice dealt with complaints positively and efficiently.
• The practice was not flushing dental lines in line with guidance and did not have a legionella risk assessment in place.
• Staff knew how to deal with emergencies. However emergency medicines and life-saving equipment were not available in line with current guidelines.
• There was lack of suitable processes for safeguarding adults at risk and children.
• The clinical staff provided patients’ care and treatment in line with current guidelines although this was not always reflected in dental care records.
• The practice did not have suitable systems to help them manage risk

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 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 systems for checking and monitoring equipment taking into account current national guidance and ensure that all equipment is well maintained.
• Review availability of medicines and equipment such as an Automated External Defibrillator (AED) to manage medical emergencies taking into account guidelines issued by the Resuscitation Council (UK), and the General Dental Council (GDC) standards for the dental team. The provider must ensure a risk assessment is undertaken if a decision is made to not have an AED on-site.
• 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 the practice’s protocols for the use of rubber dam for root canal treatment taking into account guidelines issued by the British Endodontic Society.
• Review availability of an interpreter services for patients who do not speak English as a first language.
• 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.

• Review the practice's protocol and staff awareness of their responsibilities under the Duty of candour to ensure compliance with The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
• 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 staff awareness of Gillick competency and ensure all staff are aware of their responsibilities.

During the last inspection on 21 January 2014 we saw no formal decontamination audits had been undertaken in accordance with the Department of Health (DoH) Health Technical Memorandum 01-05 to ensure the practice was meeting government standards for infection control.

We did not speak with people who use the service as part of this follow up inspection. We spoke with staff and reviewed records. We saw that staff had made improvements and systems were in place to reduce the risk and spread of cross infection. At this inspection we saw the practice had completed decontamination audits in accordance with the DoH Health Technical Memorandum 01-05.

We did not speak with people who use the service as part of this follow up inspection. We spoke with staff and reviewed records. We saw that staff had systems in place to reduce the risk and spread of cross infection. However, we saw no formal decontamination audits had been undertaken in accordance with the Health Technical Memorandum 01-05 to ensure the practice was meeting government standards.

During our last inspection we saw the provider did not always have systems in place to adequately record, monitor and review the emergency drugs kept at the practice. During this inspection we noted all of the emergency drugs were in date and had been checked on a regular basis since our last visit. We saw the systems in place to monitor record and re-order medicines for use in an emergency.

We spoke with three people attending appointments at the service. People spoke very highly about the quality of the dental care they received. People told us they felt respected by staff and were fully involved in the decisions about their dental care and treatment. Comments included “wonderful staff, they are all so caring” and “the dentist is very approachable, never flusters and always explains everything to me.”

People we spoke with found it easy to make appointments and if they had needed to be seen urgently they were accommodated. People told us they were given information about the treatment they would receive and this included how much it was going to cost them.

We observed that staff were very friendly and welcoming both in person and on the telephone.

We found that the surgery was clean and tidy and that staff understood the importance of infection control. We saw that staff were working towards best practice guidelines and had systems in place to reduce the risk and spread of cross infection.

We saw the provider did not always have systems in place to adequately record, monitor and review the emergency drugs kept at the practice.