Specialist Dental Services Ltd

We undertook a follow up focused inspection of Specialist Dental Services Ltd

on 11 November 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 Specialist Dental Services Ltd

10 June 2019 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 regulations 12 safe care and treatment, 17 good governance and 19 fit and proper person employed of the Health and Social Care Act 2008, Regulation 19 HSCA (RA) Regulations 2014 Fit and proper persons employed (Regulated Activities) Regulations 2014. You can read our report of that inspection by selecting the 'all reports' link for Specialist Dental Services Ltd on our website www.cqc.org.uk.

As part of this inspection we asked:

• 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. We then inspect again after a reasonable interval, focusing on the area(s) where improvement was required.

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 10 June 2019.

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 inspection on 10 June 2019.

Background

Specialist Dental Services Ltd is in the City of Westminster. The practice provides private treatments to patients of all ages.

Car parking spaces, including some for blue badge holders, are available near the practice.

The dental team includes 14 dentists, three dental nurses, a dental hygienist, a receptionist and the practice manager. The practice has four treatment rooms.

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 staff member registered with the CQC as the registered manager was the practice manager

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

Our key findings were:

• The provider had improved the practice infection control procedures so that they reflected published guidance.
• The provider had a staff recruitment procedure in place and carried out the necessary pre-employment checks
• The dentists and dental nurses had undertaken appropriate training including safeguarding and infection control.
• There were arrangements to ensure that the premises and equipment were fit for use. Although a gas safety check had still not been undertaken.

The practice had also made the following improvements:

• There was a risk assessment in place for when the hygienist worked without chairside support.
• Staff appraisals had been carried out for the receptionist and nurses.
• The provider had systems in place to record and learn from incidents.
• The provider had spoken to staff and put in place procedures to ensure privacy was maintained in the surgery next to the reception area.

There were areas where the provider could make improvements. They should:

• Take action to ensure the suitability of the premises and ensure all areas are fit for the purpose for which they are being used. In particular to carry out an annual gas safety check.
• Implement an effective system for recording, investigating and reviewing incidents or significant events with a view to preventing further occurrences and ensuring that improvements are made as a result. In particular ensure staff familiarise themselves with the types on incidents that would constitute a significant event.

We carried out this unannounced inspection on 10 June 2019 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

Specialist Dental Services Limited is in Westminster and provides private treatment to adults and children.

Car parking spaces, including some for blue badge holders, are available near the practice.

The dental team includes 13 dentists, two dental nurses, a dental hygienist, a receptionist and the practice manager. The practice has four treatment rooms.

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 staff member registered with the CQC as the registered manager was the previous practice manager who was no longer in post. A registered manager was not in post at the time of the inspection. The provider told us they were going to make the necessary application to cancel the current registration and appoint a new registered manager.

On the day of inspection, we received feedback from three patients.

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

The practice is open:

Monday 9.00 – 6.00pm

Tuesday 8.00am to 8.00pm

Wednesday 9.00am to 8.00pm

Thursday 8.00am to 6.00pm

Friday 9.00am to 6.00pm

Saturday 9.00am to 1.30pm

Our key findings were:

• The practice appeared clean and well maintained.
• The provider had infection control procedures which reflected published guidance. However, some improvements were required in regard to staff wearing suitable personal protective equipment such as an apron while cleaning used dental instruments.
• Staff knew how to deal with emergencies. Medicines and life-saving equipment were available. However some improvements were required.
• The provider had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children. Certificates were not available to confirm training in this area
• 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. However, some improvements were required.
• Staff were providing preventive care and supporting patients to ensure better oral health.
• The appointment system took account of patients’ needs.
• The provider was not undertaking some audits including infection control audits.
• Staff felt involved and supported and worked well as a team. However, some improvements were required.
• The provider asked staff and patients for feedback about the services they provided.
• The provider dealt with complaints positively and efficiently.
• The practice did not have recruitment procedures in line with legislation.
• The provider did not have suitable risk assessment systems in place.

We identified regulations the provider was not complying with. They must:

• Ensure that care and treatment is provided to patients in a way that is safe
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
• Ensure specified information is available regarding each person employed

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 system for documentation of actions taken, and learning shared, in response to incidents with a view to preventing further occurrences and ensuring that improvements are made as a result.

• Review the practice’s arrangements for providing chairside support for dental hygienists, ensuring that a risk assessment is in place.
• Review the staff supervision protocols and ensure an effective process is established for the on-going appraisal of all staff
• Review the arrangements for ensuring patients’ privacy is maintained in treatment rooms, treatment room next to reception area.