Little London Dental Care

We undertook a focused inspection of Little London Dental Care on 14 December 2018. 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 remotely by a specialist dental adviser.

We had undertaken a comprehensive inspection of Little London Dental Care on 05 and 08 July 2018 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 well led care in accordance with the relevant regulations 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 Little London Dental Care on our website www.cqc.org.uk.

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.

As part of this inspection we asked:

• Is it well-led?

Our findings were:

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 had found at our previous inspections on 05 and 08 July 2018.

Background

Little London Dental Care is in Chichester, West Sussex and provides NHS and private treatment to adults and children.

The practice is accessed via several steps and is situated over three floors. Car parking spaces for blue badge holders are available near the practice which is within a short walk of car parks.

The dental team includes three associate dentists, one dental hygienist, one qualified dental nurse, two trainee dental nurses, four receptionists and a practice manager who is also a qualified dental nurse. The practice has four operational 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. At the time of the inspection the practice manager was applying to be the registered manager and this application was underway.

During the inspection we spoke with the two dentists, two trainee dental nurses, three receptionists and the practice manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

• Monday to Friday from 8.30am to 5.30pm
• Saturday from 9am to 1pm (one Saturday a month by appointment only)

Our key findings were:

• The practice was providing care and treatment in a safe way to patients
• The practice had implemented effective systems and processes to ensure good governance which can be sustained in the longer term, in accordance with the fundamental standards of care.
• The practice had implemented systems to ensure that 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.
• The practice had implemented recruitment procedures to ensure that these were operated effectively and that only fit and proper persons were employed.
• The practice had ensured that specified information was available regarding each person employed.
• The practice had reviewed 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) Regulations 2014.
• The practice had reviewed staff awareness of the requirements of the Mental Capacity Act 2005 and ensured that all staff are aware of their responsibilities under the Act as it relates to their role.
• The practice had reviewed staff awareness of Gillick competency and ensured all staff are aware of their responsibilities in relation to this.
• The practice had implemented an effective system to monitor and track referrals to ensure that these are dealt with promptly.

We carried out this unannounced inspection on 05 and 11 July 2018 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 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

Little London Dental Care is in Chichester, West Sussex and provides NHS and private treatment to adults and children.

The practice is accessed via several steps and is situated over three floors. Car parking spaces for blue badge holders are available near the practice which is within a short walk of car parks.

The dental team includes three associate dentists, one dental hygienist, two trainee dental nurses, four receptionists and a practice manager. The practice has eight 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. At the time of the inspection the registered manager was no longer working at the practice having left three months prior to the inspection.

During the inspection we spoke with three dentists, two trainee dental nurses, one qualified nurse and one trainee dental nurse working temporarily at the practice. We also spoke with all the receptionists, the practice manager, and the compliance manager and the regional support manager for the company. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

• Monday to Friday from 8.30am to 5.30pm

Our key findings were:

• The clinical staff provided patients’ care and treatment in line with current guidelines.
• The practice staff had information governance arrangements.
• Staff took care to protect patients’ privacy and personal information.
• The practice was providing preventive care and supporting patients to ensure better oral health.
• The practice premises were visibly dirty and poorly maintained.
• The practice had ineffective infection control procedures which did not reflect published guidance.
• Staff knew how to deal with emergencies though medicines and life-saving equipment were not available as described in recognised guidance.
• The practice had ineffective systems to help them manage risk.
• The practice had some safeguarding processes but not all staff knew their responsibilities for safeguarding vulnerable adults and children.
• The practice had ineffective staff recruitment procedures.
• The appointment system was being reviewed to ensure it met patients’ needs.
• The practice had ineffective leadership with limited systems in place to encourage continuous improvement.
• The practice asked staff and patients for feedback about the services they provided, although the results of patient feedback were not analysed for the purpose of continually evaluating and improving services.
• The practice staff maintained a log of complaints although systems in place to deal with these were used inconsistently.

These findings were brought to the attention of the compliance manager for the company who initiated immediate action to mitigate the urgent risks.

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.
• Ensure specified information is available regarding each person employed.

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) Regulations 2014.
• Review staff awareness of the requirements of the Mental Capacity Act 2005 and ensure all staff are aware of their responsibilities under the Act as it relates to their role.
• Review staff awareness of Gillick competency and ensure all staff are aware of their responsibilities in relation to this.
• Review the practice’s systems to monitor and track referrals to ensure that these are dealt with promptly.