Alexander Langdon Dental Practice

We undertook a follow up focused inspection of Alexander Langdon Dental Practice on 29 August 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 specialist dental adviser.

We undertook a comprehensive inspection of Alexander Langdon Dental Practice on 1 May 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, effective or well led care and was in breach of regulations 12 safe care and treatment, 17 good governance and 18 staffing 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 Alexander Langdon Dental Practice on our website www.cqc.org.uk.

As part of this inspection we asked:

• Is it safe?

• Is it effective?

• Is it well-led?

When one or more of the five questions are not met we require the service to make improvements. Due to the serious level of concerns which we identified when we inspected Alexander Langdon Practice on 1 May 2019 we took urgent action to ensure people could not be exposed to a risk of harm and suspended the provider’s CQC registration for a period of three months to allow the provider to act on the risks. We then inspected again after this period, focusing on the areas where improvement was required.

Our findings were:

Are services safe?

We found this practice was providing safe care in accordance with the relevant regulations.

The provider had made improvements in relation to the regulatory breaches we found at our inspection on 1 May 2019.

Are services effective?

We found this practice was providing effective care in accordance with the relevant regulations.

The provider had made improvements in relation to the regulatory breaches we found at our inspection on 1 May 2019.

Are services well-led?

We found this practice was providing well-led care in accordance with the relevant regulations.

The provider had made improvements in relation to the regulatory breaches we found at our inspection on 1 May 2019.

Background

Alexander Langdon Dental Practice is in the London Borough of Barnet. The practice provides private treatments to patients of all ages.

The dental team includes the dentist who owns the practice.

The practice is owned by an individual who is the 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 dentist. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open: Monday to Friday from 9am to 5.00pm.

Our key findings were:

• The provider had improved the practice infection control procedures so that they reflected published guidance.
• There were effective arrangements for dealing with medical emergencies and appropriate medicines and equipment were available.
• The provider had suitable safeguarding processes and the principal dentist knew their responsibilities for safeguarding vulnerable adults and children.
• There were effective arrangements for assessing and mitigating risks to patients and staff.
• There were arrangements to ensure that the premises and equipment were fit for use.
• There were systems to ensure that and the principal dentist and other staff undertook appropriate training.
• The provider had reviewed the leadership arrangements to support a culture of continuous improvement.
• There were arrangements for receiving and responding to patient safety alerts, recalls and rapid response reports issued from the Medicines and Healthcare products Regulatory Agency (MHRA) and through the Central Alerting System (CAS), as well as from other relevant bodies, such as Public Health England (PHE).
• The practice had protocols to ensure that patient referrals were monitored suitably.
• There were arrangements to assess and plan for the needs of patients including people with disabilities and those who did not speak English as a first language or who may have difficulty understanding English.

We carried out this unannounced inspection on 01 May 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 not 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

Alexander Langdon Dental Practice is in the London Borough of Barnet. The practice provides NHS and private treatments to patients of all ages.

The dental team includes the dentist who owns the practice.

The practice is owned by an individual who is the 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 dentist. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open: Monday to Friday from 9am to 5.00pm.

Our key findings were:

• The dentist was providing preventive care and supporting patients to ensure better oral health.
• The appointment system met patients’ needs.
• The provider had suitable safeguarding processes and the dentist knew his responsibilities for safeguarding vulnerable adults and children.
• The dentist confirmed they had been working alone and without the support of a dental nurse for the past two years.

Appropriate medicines and life-saving equipment as per current national guidance were not available at the practice.

• Not all areas of the premises were suitably maintained.
• The practice infection control procedures did not reflect published guidance. Infection control audits had not been completed since 2017.
• Equipment such as the X-ray machine and the compressor unit had not been serviced and maintained in accordance with guidelines.
• Risks arising from fire and Legionella had not been suitably identified and mitigated.
• There was a lack of clinical and managerial oversight for the day-to-day running of the service.
• The practice did not have suitable information governance arrangements.

We took urgent action to ensure people could not be exposed to a risk of harm and suspended the provider’s CQC registration for a period of three months to allow the provider to act on the risks.

This notice of urgent suspension was issued because we believe that a person will or may be exposed to the risk of harm if we do not take this action.

We will be following up on our concerns to ensure they have been put right by the provider.

We also shared our concerns with relevant external authorities including NHS England and the London Fire Brigade.