We carried out this announced inspection on 28 and 29 December 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 advisor.
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
Perfect Smile West Hampstead is in Hampstead in the London borough of Camden. The practice provides NHS and private treatment to patients of all ages.
There is level access for people who use wheelchairs and those with pushchairs. Restricted car parking spaces, including those for patients with disabled badges, are available near the practice.
The dental team includes five dentists, a qualified dental nurse, a dental hygienist, a practice manager and a receptionist. The practice has three 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 registered manager at Perfect Smile West Hampstead was one of the company’s directors.
On the day of inspection we obtained feedback from 13 patients. This information gave us a positive view of the practice.
During the inspection we spoke with two dentists, two dental nurses (one of whom had been drafted in from another practice owned by the provider) and the company’s general manager and area manager. We checked practice policies and procedures and other records about how the service is managed.
The practice is open at the following times:
Monday, Tuesday, Friday: 9am-6pm
Wednesday: 9am-7pm
Alternate Saturdays: 9am-1pm
Our key findings were:
- The practice was clean and well maintained.
- Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
- The practice had safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
- 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.
- Staff felt involved and supported.
- The practice had infection control procedures, though improvements could be made to ensure the infection control audit was carried out in line with current national guidance.
- Improvements could be made to ensure the practice used rectangular collimators on all radiography equipment in line with guidance and legislation.
- The practice had systems to help them manage risk, though improvements could be made to ensure risk assessments were carried out effectively.
- The practice lacked established recruitment procedures and processes.
- Improvements could be made to ensure the practice had processes to enable them to monitor training needs.
- Improvements could be made to establish a process for receiving and sharing safety alerts such as those from the Medicines and Healthcare Products Regulatory Agency.
- The practice lacked effective leadership. Risks from the lack of effective recruitment checks, and the lack of systems to monitor quality had not been suitably identified and mitigated.
The provider assured us following our visit that they would address these issues and put immediate procedures in place to manage the risks. We have since been sent evidence to show
that improvements are being made. We will check these improvements have been sustained and embedded when we carry out a follow-up inspection of the practice.
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 recruitment procedures are established and operated effectively to ensure only fit and proper persons are 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 improvements are made as a result.
- Review its responsibilities with regard to the Control of Substances Hazardous to Health (COSHH) Regulations 2002 and ensure all documentation is up to date and staff understand how to minimise risks associated with the use and handling of these substances.
- Review the protocols and procedures for use of radiography equipment taking into account Guidance Notes for Dental Practitioners on the Safe Use of X-ray Equipment.
- Review the practice's protocols for completion of dental care records taking into account guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.
- Review the practice’s protocols for referral of patients and ensure all referrals are monitored suitably.
- Review the current staffing arrangements to ensure all dental care professionals are adequately supported by a trained member of the dental team when treating patients in a dental setting taking into account the guidance issued by the General Dental Council.
- Review its responsibilities to meet the needs of people with a disability, including those with hearing difficulties and the requirements of the Equality Act 2010.