Marais Associates Limited

We carried out this announced inspection on 17 October 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

Marais Associates Limited is in Hornchurch in the London Borough of Havering. The practice provides private dental treatment to adults and children.

. The practice is close to public transport services, located on the ground of floor of a purpose adapted building and has two treatment rooms.

The dental team includes the principal dentist, one associate dentist and one dental nurse. The clinical team are supported by practice a manager.

We collected feedback from five patients who completed CQC comment cards.

During the inspection we spoke with the principal dentist, the dental nurse and one of the company’s directors. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open between:

8am and 5pm Mondays to Thursdays

Our key findings were:

• 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.
• Staff provided preventive care and supported patients to ensure better oral health.
• The appointment system took account of patients’ needs.
• The provider had arrangement to deal with complaints positively and efficiently.
• The provider had suitable information governance arrangements
• The practice appeared clean. There were ineffective arrangements to ensure that equipment was well maintained.
• The practice infection control policies reflected published guidance. However, these were not followed consistently.
• There were ineffective arrangements for dealing with emergencies. Staff did not have appropriate training and all of the recommended emergency equipment were not available.
• The provider had ineffective systems to help them manage risk to patients and staff.
• The provider had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children. Improvements were needed to ensure that staff had appropriate levels of training in safeguarding children and adults.
• The provider’s staff recruitment procedures were not followed consistently.
• There was a lack of effective leadership and a culture of continuous improvement.
• There were ineffective systems to monitor staff training and development needs.

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.
• Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out the duties.
• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.

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

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

• Implement an effective system for monitoring and recording the fridge temperature to ensure that medicines and dental care products are being stored in line with the manufacturer’s guidance.
• Take action to ensure the availability of equipment in the practice to manage medical emergencies taking into account the guidelines issued by the Resuscitation Council (UK) and the General Dental Council.
• Implement an effective system for receiving and responding to patient safety alerts, recalls and rapid response reports issued by the Medicines and Healthcare products Regulatory Agency, the Central Alerting System and other relevant bodies, such as Public Health England.
• Review the practice protocols regarding audits for prescribing of antibiotic medicines taking into account the guidance provided by the Faculty of General Dental Practice.
• Review the practice protocol regarding auditing patient dental records to check that the necessary information is recorded.
• Take action to ensure the service takes into account the needs of patients with disabilities and to comply with the requirements of the Equality Act 2010.