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Inspection carried out on 19 April 2018

During an inspection to make sure that the improvements required had been made

We carried out a focused inspection of Wood Street Dental Practice on 19 April 2018.

The inspection was led by a CQC inspector who had remote access to a specialist dental adviser.

We carried out the inspection to follow up concerns we originally identified during a comprehensive inspection at this practice on 8 November 2017 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions.

At a comprehensive inspection we always ask the following five questions to get to the heart of patients’ experiences of care and treatment:

  • Is it safe?
  • Is it effective?
  • Is it caring?
  • Is it responsive to people’s needs?
  • Is it well-led?

When one or more of the five questions is 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.

At the previous comprehensive inspection we found the registered provider was providing safe, effective, caring and responsive care in accordance with relevant regulations. We judged the practice was not providing well-led care in accordance with Regulation 17 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 Wood Street Dental Practice on our website www.cqc.org.uk.

We also reviewed the key questions of safe and effective as we had made recommendations for the provider relating to these key questions. We noted that improvements had been made.

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 to put right the shortfalls and deal with the regulatory breach we found at our inspection on 8 November 2017.

Inspection carried out on 8 November 2017

During a routine inspection

We carried out this announced inspection on 8 November 2017 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 Care Quality Commission (CQC) inspector who was supported by a specialist dental adviser.

We told the NHS England area team that we were inspecting the practice. They did not provide any information.

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

Wood Street Dental Practice is located in Walthamstow, in the London Borough of Waltham Forest. The practice provides NHS and private dental treatments to patients of all ages.

The practice is located on the ground floor of a purpose adapted leased premises. The practice has three treatment rooms. The practice is conveniently located close to public transport links.

The dental team includes the principal dentist and associate dentist, one qualified dental nurse, one trainee dental nurse and a receptionist.

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.

We received feedback from 29 patients via CQC comment cards and speaking with patients. This information gave us a positive view of the practice.

During the inspection we spoke the principal dentist and the associate dentist, both dental nurses and the receptionist. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open between 9am and 5pm on Mondays to Thursdays and between 9am and 1pm on Fridays.

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Our key findings were:

  • The practice was clean and well maintained.
  • The practice had thorough staff recruitment procedures.
  • 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.
  • The appointment system met patients’ needs.
  • The practice asked staff and patients for feedback about the services they provided.
  • The practice dealt with complaints positively and efficiently.
  • The practice had safeguarding processes and procedures. However staff had not undertaken training and staff were unclear about their responsibilities for safeguarding adults and children.
  • The practice had infection control procedures which reflected published guidance. However there were limited systems for quality assurance of these procedures in line with published guidance.
  • Staff knew how to deal with emergencies. Some items of life-saving equipment and medicines as per current national guidelines were however not available or were past their expiry date. The practice responded immediately to procure these pieces of equipment.
  • The practice had some systems to help them assess and manage risk. These were not always consistent or in line with current guidance and legislation.

We identified regulations the provider was not meeting.

They must:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

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 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).

  • Review the practice’s sharps procedures and ensure the practice is in compliance with the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.
  • Review the systems for checking and monitoring electrical equipment taking into account current national guidance and ensure that all equipment is well maintained.
  • Review the protocols and procedures for use of X-ray equipment taking into account Guidance Notes for Dental Practitioners on the Safe Use of X-ray Equipment.
  • Review the practice’s protocols for recording in the patients’ dental care records or elsewhere the reason for taking the X-ray and quality of the X-ray ensuring compliance with the Ionising Radiation (Medical Exposure) Regulations (IRMER) 2000.
  • Review the training, learning and development needs of individual staff members at appropriate intervals and ensure an effective process is established for the on-going assessment, supervision and appraisal of all staff.

Inspection carried out on 11 January 2013

During a routine inspection

People told us that the dentists were patient and kind. One person said, "I chose this practice because the staff have a way to keep me calm."

We found that dental records included oral assessments, past medical histories and treatment plans. People told us that they were involved in their care and treatment and that information about fees and treatment was always made available.

People were given the opportunity to comment about the care and treatment they received and action was taken where required. Staff had regular meetings and felt supported to continue their professional development.

We observed that there was a clean waiting area with adequate seating. We reviewed infection control policies and observed practice. We found that hand washing was adhered to, waste was disposed of appropriately.