Michael Carling Harley Street

We carried out this announced comprehensive on 19 July 2023 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 practice 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.

To get to the heart of patients’ experiences of care and treatment, we always ask the following 5

• 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:

• The dental clinic appeared clean and well-maintained.
• The practice had infection control procedures which reflected published guidance.
• The practice had systems to manage risks for patients, staff, equipment and the premises.
• The practice had staff recruitment procedures. Improvements were required to ensure satisfactory evidence of conduct in previous employment (references) were taken and appropriately recorded.
• Clinical staff provided patients’ care and treatment in line with current guidelines.
• Patients were treated with dignity and respect. Staff took care to protect patients’ privacy and personal information.
• Staff provided preventive care and supported patients to ensure better oral health.
• The appointment system worked efficiently to respond to patients’ needs.
• The frequency of appointments was agreed between the dentist and the patient, giving due regard to National Institute of Health and Care Excellence (NICE) guidelines.
• Staff felt involved, supported and worked as a team.
• Staff and patients were asked for feedback about the services provided.
• Complaints were dealt with positively and efficiently.
• The practice had information governance arrangements.
• Staff knew how to deal with medical emergencies. Most appropriate medicines and life-saving equipment were available. However, improvements were required to ensure buccal midazolam and glucagon were available and appropriate checks were made on the emergency drug kit.
• Not all staff who supported conscious sedation had carried out Immediate Life Support (ILS) or equivalent training.
• Safeguarding processes were in place and staff knew their responsibilities for safeguarding children, improvements were required in regards to the practice’s vulnerable adults safeguarding policy.
• There was a lack of oversight in regard to some areas of the practice’s governance and risk management such as medical emergencies and sedation.

There was lack of clarity as to why certain patients requiring conscious sedation in a secondary setting had been treated at the practice.

We brought our concerns related to conscious sedation to the attention of the principal dentist. They informed us that they had voluntarily decided, with immediate effect, to stop carrying out dental treatment using conscious sedation at the practice.

Background

Michael Carling Harley Street is in Westminster and provides private dental care and treatment for adults and children.

The practice is located on the 1st floor of the builidng it is located in and not accessible for people who use wheelchairs and those with pushchairs. Arrangements were in place to refer patients who could not access the building to other practice.

The dental team includes 4 dentists ( including the principal dentist), 2 dental nurses, 1 trainee dental nurse, 3 dental therapists,1 receptionist and the practice manager. The practice has 3 treatment rooms.

During the inspection we spoke with the principal dentist, 2 dental nurses, a receptionist and the practice manager. We looked at practice policies, procedures and other records to assess how the service is managed.

The practice is open:

Monday to Friday from 8.30am to 6pm

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:

• Implement audits for prescribing of antibiotic medicines taking into account the guidance provided by the College of General Dentistry.