We carried out an announced comprehensive inspection of this practice on 17 November 2015. A breach of legal requirements was found. After the comprehensive inspection, the practice wrote to us to say what they would do to meet legal requirements in relation to the breach.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Wigmore Dental Clinic on our website at www.cqc.org.uk.

Our findings were:

Are services well-led?

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

Background

Wigmore Dental Clinic is a private dental practice situated in the Wigmore area of Luton.

The practice is open from 9.00 am to 6.15 pm Monday, Tuesday, Thursday and Friday. The practice is closed on Wednesday.

The principal dentist 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.

The CQC inspected the practice on 17 November 2015 and asked the provider to make improvements regarding equipment maintenance and conscious sedation. We checked these areas as part of this desk based inspection and found this had been resolved.

Our key findings were:

• The practice had implemented a system whereby any report from servicing or testing of equipment be logged as a significant event. This ensured that both clinician and practice manager be informed and there is no chance of an oversight.

• The practice was not performing conscious sedation (these are techniques in which the use of a drug or drugs produces a state of depression of the central nervous system enabling treatment to be carried out, but during which verbal contact with the patient is maintained throughout the period of sedation).

We carried out an announced comprehensive inspection on 17 November 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 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

Wigmore Dental Clinic is a private dental practice situated in the Wigmore area of Luton.

The practice is open from 9.00 am to 6.15 pm Monday, Tuesday, Thursday and Friday. The practice is closed on Wednesday.

There is currently one dentist working at Wigmore Dental Clinic, and the practice offers a wide range of dental procedures including short term orthodontics (a term used to describe quick orthodontic treatments that usually only affect the front teeth. These types of systems can use transparent trays instead of conventional braces to effect simple tooth movements) and “smile design” where teeth are cosmetically altered using a variety of restorative means to improve the overall appearance of the smile. These are in addition to a full range of general dental treatments (for example, fillings, root fillings, crowns, bridges and dentures) and oral surgery.

The practice offers ‘occasional’ conscious sedation (this is a technique in which the use of a medicine or medicines produces a state of depression of the central nervous system enabling treatment to be carried out, but during which verbal contact with the patient is maintained) but most patients requesting this treatment were referred to a specialist centre.

A visiting dentist attends the practice occasionally to fit dental implants as and when requested by the principal dentist. A dental implant is a metal post that is placed surgically below the gum line with a ceramic tooth, bridge or denture on top. It is used to replace a single missing tooth or multiple missing teeth.

The Principal Dentist is the registered manager. A registered manager is a person who is registered with the Care Quality Commission (CQC) to manage the service. 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.

We received feedback on the service by 21 patients, either by way of them filling in a CQC comment card or in person. They were overwhelmingly positive about the service offered, and made particular reference to the friendliness of the whole team, and how clean and hygienic the premises seemed to them.

Our key findings were:

• There was appropriate equipment for staff to undertake their duties, and most equipment was well maintained.

• The practice was carrying out effective infection control procedures, as described in the ‘Health Technical Memorandum 01-05 (HTM 01-05): Decontamination in primary care dental practices.’ Published by the Department of Health.

• The practice had systems, processes and policies in place to monitor and manage risks to patients, staff and visitors to the practice.

• Feedback from patients described the service as friendly, kind and caring. Particular reference was made to the staffs’ ability to reassure nervous patients and put them at ease.

• Patient dental care records provided an accurate, thorough and contemporaneous record of patient care.

• The practice had a comprehensive schedule of clinical audit demonstrating their commitment to continuous improvement.

• The practice had failed to recognise that X-ray units were working outside of expected parameters.

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

• Ensure robust systems are in place to monitor and recognise concerns raised following routine testing of X-ray equipment.
• Ensure the practice pays due regard to guidelines published by The Intercollegiate Advisory Committee on Sedation in Dentistry in the document 'Standards for Conscious Sedation in the Provision of Dental Care 2015’. This should include a review of practice’s protocols for conscious sedation as well as a system to ensure that dentists carrying out conscious sedation and dental nursing staff who are assisting in conscious sedation have the appropriate training and skills to carry out that role.

You can see full details of the regulations not being met at the end of this report.

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

• Review systems to ensure that the practice is in compliance with its legal obligations under Ionising Radiation Regulations (IRR) 99 and Ionising Radiation (Medical Exposure) Regulation (IRMER) 2000.

• Review systems to 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.

• 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 practice’s protocols for the use of rubber dam for root canal treatment giving due regard to guidelines issued by the British Endodontic Society

• 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.

During our visit to the service on 30 October 2012 we spoke with four people who were waiting for or had received treatment; Two adults and two young people. Everyone we spoke with told us that the staff treated them respectfully. One person said “We’ve been coming as a family to this practice for over 20 years and we are all very happy with the service”. Another person said, “Everyone is friendly and kind”.

Throughout our visit people told us that the dentist was good at explaining things to them and we saw from the records that any explanations or options the dentist discussed with people were recorded. We also saw clear information brochures about the service, the opening hours and the various methods of payments.

The surgery was on the ground floor allowing access for people with limited mobility. There was a range of toys and books suitable for children and all treatment and confidential discussions were carried out in the privacy of a treatment room.

People told us that they felt safe, relaxed and confident in the surgery as a result of the environment and the staff team.

We saw that people were given the opportunity to make a complaint if they felt it necessary, although no one we spoke with suggested they would need to do this.