Archived: The Gentle Dentist

We carried out an announced inspection on 18 May 2021 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.

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 three questions were asked:

• Is it safe?

• Is it effective?

• Is it well-led?

These questions form the main framework for the areas we look at during the inspection.

Our findings were:

Are services safe?

We found this practice was not providing safe care in accordance with the relevant regulations.

Are services effective?

We found this practice was not providing effective 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

The Gentle Dentist is located in London's West End of Covent Garden in the London Borough of Camden. Recent published data shows that oral health in Camden was comparable to other London boroughs, however it was higher than England average. The practice provides private treatments to patients of all ages from a converted terraced property. The practice offered conscious sedation to adults which is undertaken by a visiting anaesthesiologist and the principal dentist.

The first two floors of the building consist of four surgeries, a separate decontamination room, reception area and a waiting room. The third floor is a flat where the provider resides. There was also a dental laboratory, however this was a separate entity to the practice.

The practice is situated close to public transportation services and local amenities including supermarkets and a post office.

The dental team includes the principal dentist who leased the practice, a visiting specialist orthodontist, a visiting endodontist, two dental hygienists, two full time dental nurses and a full-time practice manager.

The practice is run 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.

The practice is open:

Monday: 09:00 - 20:00

Tuesday: 09:00 - 21:00

Wednesday: 08:00 - 18:00

Thursday: 08:00 - 18:00

Friday: 08:00 - 16:00

During out of hours, patients are advised to contact the dedicated phone number for advice and or treatment.

On the day of the inspection we spoke with the principal dentist, two dental nurses, one dental hygienist, one receptionist/practice manager. We looked at practice policies and procedures and other records about how the service is managed.

Our key findings were:

• The practice appeared to be visibly clean and well-maintained.
• Staff had access to personal protective equipment (PPE), however they had not been fit tested for respiratory protective equipment.
• The provider had safeguarding policies and procedures to provide staff with information about identifying, reporting and dealing with suspected abuse.
• The provider had not taken reasonable steps to identify, mitigate and manage the risks to patients specifically to those relating to fire safety, legionella and electrical safety.
• We found patients were at risk of harm as the provider was failing to comply with national guidance on conscious sedation in primary dental care settings.
• We found recruitment checks needed improving to keep patients safe.
• The provider did not have processes to receive patient safety alerts.
• Staff treated patients with dignity and respect and took care to protect their privacy.
• Staff provided preventive care and supported patients to ensure better oral health.
• The appointment system took account of patients’ needs.
• Staff felt involved and supported and worked as a team.
• The provider’s information governance arrangements needed improving to safeguard patients’ personal information.

We identified regulations the provider was not complying with. 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

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

• Take action to ensure all clinicians 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.
• Improve the practice's complaint handling procedures and establish an accessible system for identifying, receiving, recording, handling and responding to complaints by service users.
• Review all policies and procedures to ensure they reflect the way the practice operates.