We undertook a follow up focused inspection of Your Dentist London on 27 February 2019. 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 Your Dentist London on 15 August 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 safe or well led care and was in breach of regulation 12 - Safe care and treatment and 17 – Good governance 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 Your Dentist London on our website www.cqc.org.uk.

• Is it safe?

• Is it well-led?

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.

Our findings were:

Are services safe?

We found that this practice was providing safe care in accordance with the relevant regulations. The provider had made improvements in relation to the regulatory breach we found at our inspection on 15 August 2018.

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 we found at our inspection on 15 August 2018.

Background

Your Dentist London is in Victoria in the London Borough of Westminster. The practice provides private treatment to patients of all ages.

The practice has three treatment rooms, located on the ground floor; two were in use at the time of our inspection. The practice is situated close to public transport bus and train services.

The dental team includes the principal dentist and three associate dentists. Two dental nurses also work at the practice. The clinical team are supported by a compliance manager and a receptionist.

The practice is owned by a company 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 Your Dentist London was the principal dentist.

During the inspection we spoke with the principal dentist, one associate dentist, one 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:

Mondays, Tuesdays, Thursdays and Fridays between 8.30am and 6pm.

Wednesdays between 10.30am and 8pm

Our key findings were:

• There were suitable safeguarding arrangements in place and staff had access to information to assist them to report concerns.

• Improvements had been made to the arrangements for ensuring that equipment used to sterilise dental instruments was serviced and maintained in line with the manufacturer’s instructions.

• There were arrangements to monitor and improve quality in relation to dental radiography though a system of audits.

• There suitable systems in place to deal with medical emergencies. The recommended life-saving equipment and medicines were available and staff had completed training in medical emergencies.

• Improvements had been made to the arrangements for assessing and mitigating Legionella risks within the practice.

• The practice infection control procedures had been reviewed and improved so that infection prevention and control audits were carried out in line with current guidance.

• Improvements had been made to the arrangements for recording, investigating, learning from incidents or significant events with a view to preventing further occurrences.

• Information in relation to safety including patient safety alerts, recalls and rapid response reports issued from the Medicines and Healthcare products Regulatory Agency (MHRA) were reviewed and shared to help monitor and improve safety.

• The practice’s sharps procedures were in compliance with the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.

• Improvements had been made to the arrangements to respond to the needs of patients with disability and the requirements of the Equality Act 2010.

We carried out this announced inspection on 15 August 2018 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.

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

Your Dentist London is in Victoria in the London Borough of Westminster. The practice provides private treatment to patients of all ages.

The practice has three treatment rooms located on the ground floor; two were in use at the time of our inspection. The practice is situated close to public transport bus and train services.

The dental team includes the principal dentist and three associate dentists. Two dental nurses also work at the practice. The clinical team are supported by a compliance manager and a receptionist.

The practice is owned by a company 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 Your Dentist London was the principal dentist.

We did not receive feedback from any patients on the day of the day of inspection. We reviewed comments made by 50 patients who had completed online reviews and testimonials.

During the inspection we spoke with the principal dentist, one associate dentist, the compliance manager, one 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:

Mondays, Tuesdays, Thursdays and Fridays between 8.30am and 6pm.

Wednesdays between 10.30am and 8pm.

Our key findings were:

• The practice appeared clean.
• The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• 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 practice was providing preventive care and supporting patients to ensure better oral health.
• The appointment system met patients’ needs.
• The practice asked and patients for feedback about the services they provided.
• The practice had procedures in place to deal with complaints positively and efficiently.
• The practice had suitable information governance arrangements.
• The practice had clearly defined leadership. There were some systems to help them assess and manage risk. However these were not always consistent or in line with current guidance and legislation.
• The practice had infection control procedures which reflected published guidance. Improvements were needed so that infection control audits were carried out in line with current guidance.
• Staff knew how to deal with emergencies. Improvements were needed to ensure that appropriate medicines and life-saving equipment were available.
• Improvements were needed so that staff had access to appropriate information and were supported and monitored so that they understood and adhered to the practice policies and procedures,

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

• Ensure care and treatment is provided in a safe way to patients

• 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 staff training to ensure that all staff who are assisting in conscious sedation have the appropriate training and skills to carry out the role taking into account 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.
• Review its responsibilities to respond to the needs of patients with disability and the requirements of the Equality Act 2010.