Archived: London Aldgate

We carried out this announced inspection on 19 November 2021 under section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We planned the inspection to follow up on information of concern we received and 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 CQC specialist dental advisor.

To get to the heart of patients’ experiences of care and treatment, we usually ask five key questions; however, due to the ongoing pandemic and to reduce time spent on site, only the following two questions were asked:

Is it safe?

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

Are services well-led?

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

Background

London Aldgate is located in the London Borough of Tower Hamlets and provides direct to consumer aligner treatments to adults and children over the age of 12 years.

There is level access to the premises for people who use wheelchairs and those with pushchairs. The service is close to public transport facilities. Car parking spaces are available near the practice.

The practice is owned by a company and as a condition of registration must have a person registered with the CQC 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. At the time of completing this inspection report there was no registered manager in post as required as a condition of registration.

The smile shop team consists nine smile guides who carry out the intra-oral scans. This team is supported by a district manager and a people and organisation manager. The shop has four scanning suites. A team of dentists who work remotely assess scans and other information provided to determine the suitability of the aligner treatment.

During the inspection we spoke with three smile guides, the district manager and the people and organisation manager. Following the inspection, we spoke with the registered manager for the service at that time of the inspection.

The practice is open:

10am to 6pm Mondays to Fridays

9am to 5pm on Saturdays

Our key findings were:

• The practice appeared to be visibly clean and well-maintained.
• The provider had infection control procedures which reflected published guidance. These include arrangements to manage risks of COVID-19 virus in accordance with current guidelines.
• The provider had systems to help them manage risk to patients and staff.
• The provider had safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
• The provider had staff recruitment procedures which reflected current legislation. However, records in relation to the checks carried out for dentists engaged in carrying out regulated activities were not available and not provided when requested.
• The provider had arrangements to monitor the competence, skills and experience of staff. However, records in relation to dentists engaged in carrying out regulated activities were not available and not provided when requested.
• Staff felt involved and supported and worked as a team.
• The provider had information governance arrangements.

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

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

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

• Consider taking an initial pre-treatment photograph in profile. This will help the supervising clinician assess any skeletal element that might affect the treatment planning.
• Discuss possible complications of aligner treatment at the initial consultation to ensure understanding and validate consent in addition to the written documentation filled in by the person receiving care.
• Consider taking a scan and photographs when aligner treatment is completed. This will enable the effectiveness of treatment to be monitored and compared.
• Review staff awareness of Gillick competency and ensure all staff are aware of their responsibilities.
• Review the practice’s systems for analysing the results of audits and reviews to identify, share and act on areas for improvement where appropriate.