The White House Dental Practice

We carried out this unannounced comprehensive inspection on 20 April 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 second CQC inspector and a specialist dental advisor.

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

• The dental clinic appeared clean and well-maintained.
• The practice had infection control procedures which reflected published guidance.
• Clinical staff provided patients’ care and treatment in line with current guidelines.
• 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.
• Complaints were dealt with positively and efficiently.
• Patients were asked for feedback about the services provided
• Safeguarding processes were in place and staff knew their responsibilities for safeguarding vulnerable adults and children. Improvements were required to ensure all staff completed safeguarding training at a level appropriate to their role.
• Appropriate medicines and life-saving equipment were available, and staff we spoke with knew how to deal with medical emergencies. Improvements were however required to ensure all staff received Basic Life Support training.
• The practice did not have effective systems to help them manage risks to patients and staff.
• There were ineffective systems to support continuous improvement.
• There were ineffective systems to ensure that staff were up to date with their training.
• The practice did not have staff recruitment procedures which reflected current legislation.
• Improvements were needed to the Information Governance policy to take account of the General Data Protection Regulation (GDPR) 2018 requirements.
• Staff generally worked as a team. Improvements were needed to ensure that they were supported and involved in the delivery of care and treatment.
• There was ineffective leadership and a lack of oversight for the day-to-day management of the service.

Background

The White House Dental Practice is in Southall, within the London Borough of Ealing and provides NHS dental care and treatment for adults and children.

There is step free access to the practice for people who use wheelchairs and those with pushchairs. Car parking spaces, including dedicated parking for disabled people, are available near the practice. The practice has made reasonable adjustments to support patients with access requirements.

The dental team includes 2 principal dentists, 10 associate dentists, 2 foundation training dentists, 2 dental therapists, 10 dental nurses, 1 compliance administrator, 4 receptionists and 2 account and practice managers. The practice has 8 treatment rooms.

During the inspection we spoke with one of the principal dentists, a foundation training dentist, a dental nurse, 2 trainee dental nurses, 2 receptionists and the compliance administrator. We also spoke with a compliance consultant. Following the inspection, we spoke with the other principal dentist. We looked at practice policies, procedures and other records to assess how the service is managed.

The practice is open:

Monday to Friday from 9am to 6pm

Saturday from 9am to 5pm

Sunday open for NHS 111 dental emergency service

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.
• 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 their 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.

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:

• Improve the practice's protocols and procedures for the use of X-ray equipment in compliance with The Ionising Radiations Regulations 2017 and Ionising Radiation (Medical Exposure) Regulations 2017 and taking into account the guidance for Dental Practitioners on the Safe Use of X-ray Equipment.
• Implement systems for environmental cleaning taking into account the guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices.
• Implement audits for prescribing of antibiotic medicines taking into account the guidance provided by the College of General Dentistry.
• Improve the practice protocols regarding auditing patient dental care records to check that necessary information is recorded.