We undertook a follow up focused inspection of Woodlane Dental Practice on 3 September 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 Woodlane Dental Practice on 23 November 2017 and a focused inspection on 24 May 2018 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 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 reports of that inspection by selecting the 'all reports' link for Woodlane dental practice on our website www.cqc.org.uk.

As part of this inspection we asked:

• Is it well-led?

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 in relation to the regulatory breaches we found at our inspections on 23 November 2017 and 24 May 2018.

Background

Woodlane Dental Practice is in Dagenham in the London Borough of Barking and Dagenham and provides NHS and private treatment to adults and children. The practice is located on the ground floor of a purpose adapted premises. The practice has one treatment room. The practice is conveniently located close to public transport links.

The dental team includes the principal dentist who owns the dental practice, one dentist, two trainee dental nurses 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 principal dentist, one trainee 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 between 9am and 5.30pm on Mondays to Fridays.

Our key findings were:

• The practice had arrangements to report, investigate, respond and learn from accidents, incidents and significant events.

• The practice had safeguarding processes and procedures. Staff had undertaken training and staff were clear about their responsibilities for safeguarding adults and children.

• There were arrangements to protect patients and staff from accidental exposure to substances which may be hazardous to health such as cleaning and other materials.

• Staff knew how to deal with emergencies and the proper use and storage of emergency medicines and equipment. There were arrangements to ensure that medicines and equipment were available for use and within their expiry date.

• The practice had systems to help them assess and manage risk. These were in line with current guidance and legislation. Risks associated with the use of dental sharps, substances that may be hazardous to health, fire and infection control and Legionella were assessed and there were arrangements in place to minimise the risks to patients and staff.

We carried out a focused inspection of Woodlane Dental Practice on 24 May 2018.

The inspection was led by a CQC inspector who was supported by a specialist dental adviser.

We carried out the inspection to follow up concerns we originally identified during a comprehensive inspection at this practice on 22 November 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 and Regulation 18 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 Woodlane Dental Practice 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 the majority of improvements had not been made.

Our findings were:

Are services well-led?

We found this practice was not providing well-led care in accordance with the relevant regulations.

The provider had not made improvements to put right the shortfalls and deal with the regulatory breaches we found at our inspection on 22 November 2017.

We have told the provider to take action (see full details of this action in the Enforcement Actions section at the end of this report).

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.

• Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out the duties.

The Commission is considering its range of enforcement powers to secure improvements.

We carried out this announced inspection on 22 November 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

Woodlane Dental Practice 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 ground floor of a purpose adapted premises. The practice has one treatment room. The practice is conveniently located close to public transport links.

The dental team includes the principal dentist and one associate dentist, three trainee dental nurses and a receptionist.

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.

We received feedback from 13 patients via CQC comment cards. This information gave us a positive view of the practice.

During the inspection we spoke the principal dentist and the 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 5.30pm on Mondays to Fridays.

Our key findings were:

• The practice was clean and well maintained.
• 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 limited arrangements to report, investigate, respond and learn from accidents, incidents and significant events.
• There were limited arrangements to protect patients and staff from accidental exposure to substances which may be hazardous to health such as cleaning and other materials.
• The practice had safeguarding processes and procedures. However staff had not undertaken training and staff were unclear about their responsibilities for safeguarding adults and children.
• 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 did not know how to deal with emergencies or the proper use and storage of some emergency 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.

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.

• Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out the duties.

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 sharps procedures and ensure the practice is in compliance with the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.
• Review the practice’s audit protocols to ensure infection control audits are undertaken at regular intervals and where applicable learning points are documented and shared with all relevant staff.
• Review the systems for checking and monitoring equipment taking into account current national guidance and ensure that all equipment is well maintained.
• 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 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.

People we spoke with expressed satisfaction with the service. Comments included, “It is brilliant.” and “It is the best dentist I have ever been to.” We were told that the appointment system works well, and people can get an appointment quickly, at a time of their choosing. People said that treatments and any costs were always clearly explained to them by the dentist.