Moya Dental Practice

We undertook a follow up inspection of Moya Dental Practice on 9 December 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 second CQC inspector and a specialist dental adviser.

We undertook a comprehensive inspection of Moya Dental Practice on 26 April 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 12,17 and 19 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 Moya Dental Practice 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 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 this practice was not providing safe care in accordance with the relevant regulations.

The provider had made insufficient improvements to put right the shortfalls and had not responded to the regulatory breaches we found at our inspection on 26 April 2019.

Are services well-led?

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

The provider had made insufficient improvements to put right the shortfalls and had not responded to the regulatory breaches we found at our inspection on 26 April 2019.

Background

Moya Dental Practice is in Wallington in the London borough of Sutton and provides NHS and private treatment for adults and children.

There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces, including spaces for blue badge holders, are available near the practice.

The practice is owned by a partnership 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 Moya Dental Practice is the one of the principal dentists.

The practice is owned 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.

During the inspection we spoke with the registered manager (who is also one of the principal dentists) and three reception staff. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

8.45am – 5.00pm Monday to Fridays. Appointments are available up to 7.00pm on Tuesdays.

Our key findings were:

• The practice had improved with regards to completion of dental care records.

• A sharps risk assessment had been completed.

• Improvements had been made with regards to ensuring that information specified in Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014 was available for each employed person.

• Evidence was still unavailable on the day of the inspection to confirm the practice’s procedures for risk assessment, including fire risk and completion of fire drills.

• Cupboards causing obstruction to access in the accessible patient’s toilet had still not been removed.

• External clinical waste was still secured insecurely.

• Evidence was still unavailable on the day of the inspection to confirm that X-ray equipment had been serviced. Staff could not locate a radiation protection file neither confirm if there was an appointed Radiation Protection Adviser (RPA).

• Domestic cleaning had improved but further improvements were required. There were still numerous infection control issues.

• The practice still needed to review their protocols and staff awareness of their responsibilities in relation to the duty of candour to ensure compliance with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

• Evidence of the practice completing a disability access audit was still unavailable.

• Systems for auditing for continuous improvements were still not in place.

• Governance arrangements which operated effectively to ensure compliance with the requirements of the fundamental standards as set out in the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014 were still not in place.

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

• Ensure care and treatment must be provided in a safe way for service users.

• Ensure systems or processes must be established and operated effectively to ensure compliance with the requirements of the fundamental standards as set out in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Full details of the regulations the provider was not meeting are at the end of this report.

We carried out this announced inspection on 26 April 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

Moya Dental Practice is in Wallington in the London borough of Sutton and provides NHS and private treatment to adults and children.

There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces, including spaces for blue badge holders, are available near the practice.

The dental team includes a practice manager, two dentists, two dental nurses, one dental hygienist, and one receptionist (who is a qualified nurse and provides nursing cover if required). The practice has two 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 Moya Dental Practice is one of the practice owners.

On the day of inspection, we collected nine CQC comment cards filled in by patients.

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

The practice is open: 8.45am to 5.00pm Monday to Fridays. Late evening appointments are available up to 7.00pm on Tuesdays.

Our key findings were:

• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• The provider had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• Staff were providing preventive care and supporting patients to ensure better oral health.
• The appointment system took account of patients’ needs.
• Staff felt involved and supported and worked well as a team.
• The provider asked staff and patients for feedback about the services they provided.
• The provider dealt with complaints positively and efficiently.
• The provider had infection control procedures which broadly reflected published guidance, although improvements were required.
• Improvements were required with regards to domestic cleaning and general condition of equipment and the décor of the dental surgeries.
• The clinical staff provided patients’ care and treatment in line with current guidelines. Although this was not always documented in patients dental care records.
• Improvements were required with regards to governance arrangements.
• Improvements were required with regards to having systems in place continuously manage risk to patients and staff.
• The provider did not follow current legislation in ensuring recruitment checks were undertaken suitably for employees as part of the recruitment procedure.
• The provider did not demonstrate effective leadership nor was there a culture of continuous improvement.

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 protocol and staff awareness of their responsibilities in relation to the duty of candour to ensure compliance with the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014.
• Review the practice's protocols for completion of dental care records taking into account the guidance provided by the Faculty of General Dental Practice.