Dental Care London

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

We found this practice was not providing well-led care in accordance with the relevant regulations. We will be following up on our concerns to ensure the provider had made the required improvements.

During our inspection of this key question, we found the registered person had ineffective systems or processes to enable them to assess, monitor and improve the quality and safety of the services being provided. We also found ineffective systems or processes to assess, monitor and mitigate the risks relating to the health, safety and welfare of service users and others who may be at risk. In particular, relating to fire safety, recruitment procedures, radiation safety, and oversight of continuing professional development.

The registered person had ineffective systems or processes to enable them to assess, monitor and improve the quality and safety of the services being provided.

We also found the registered person had systems or processes in place that operating ineffectively in that they failed to enable the registered person to ensure that accurate, complete and contemporaneous records were being maintained securely in respect of each service user.

This resulted in a breach of Regulation 17, Good governance.

You can find more details of our concerns in the detailed findings below.

Find out what we look at when we assess this area in our information about our new Single assessment framework.

The judgement for Shared direction and culture is based on the latest evidence we assessed for the Well-led key question.

The judgement for Capable, compassionate and inclusive leaders is based on the latest evidence we assessed for the Well-led key question.

The judgement for Freedom to speak up is based on the latest evidence we assessed for the Well-led key question.

The judgement for Workforce equality, diversity and inclusion is based on the latest evidence we assessed for the Well-led key question.

We found staff to be open, honest and receptive to discussion and feedback throughout the inspection. Where concerns were identified, the provider took prompt action to begin addressing some of the issues raised. In particular, the provider arranged basic life support and medical emergency training along with infection prevention and control training for all staff. Additionally, the provider gave assurances that the infection prevention and control and dental unit waterline concerns had been rectified with immediate effect. While we recognised the positive steps taken in response to our feedback, many of the improvements had been implemented after the inspection and therefore had not been embedded or tested in practice at the time of our assessment.

We found that staff members worked well together. However, risks were not managed effectively and there was a lack of effective oversight of the service. The provider told us they had relied on information and practices acquired from experience in a previous role. However, they had not identified that some of this information was inaccurate or no longer reflected current legislation, guidance and recognised best practice. Our inspection identified concerns and omissions across a number of areas, including risk assessment and management, the provision of medical emergency equipment and training, staff recruitment processes, infection prevention and control arrangements, record keeping and governance systems. In many cases, existing monitoring and assurance processes had failed to identify these issues, meaning risks were not adequately assessed, mitigated or reviewed effectively.

The practice had an ineffective governance system. It did not include key policies and procedures, and we were not assured that staff could easily access them. In particular, missing policies included but were not limited to: recruitment, whistleblowing, laser safety and consent. The policies which were available lacked sufficient detail to effectively guide staff in their roles and responsibilities. There were no sharps or lone working risk assessments. Oversight of the practice and knowledge of the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 also required improvement.

The information and evidence presented during the inspection was not well documented. Following our inspection, the provider was invited to submit additional evidence if it was available, but no further useful documentation was received.

Staff were aware of the importance of protecting patients’ personal information. Staff password protected patients’ electronic care records, and paper records were stored securely and complied with General Data Protection Regulations.

A Data Protection Impact Assessment had been carried out with regard to the use of closed-circuit television (CCTV). However, there was no relevant policy in place.

The practice had some systems and processes in place to monitor quality and support improvement.. Infection Prevention and Control audits were not undertaken at 6 monthly intervals and were not designed or carried out effectively to identify areas for improvement. Radiographic audits were undertaken at regular intervals; however, the sample size reviewed was significantly smaller than that recommended in published guidance limiting the assurance they provided. .. Improvements could be made to ensure that audits were sufficiently robust to identify gaps in processes, especially those relating to record keeping. In addition, further improvements were required to ensure that continuous learning was effectively supported through robust monitoring of training and regular appraisal of individual development needs. Overall systems for monitoring quality and performance had not effectively identify areas for improvement and were not used to drive meaningful changes in practice.

Concerns and complaints were responded to appropriately, and outcomes were discussed to share learning and for improvement. However, the complaints procedure was not displayed at the practice on the day of inspection, although it was available within the practice website. Improvements were needed to ensure information and guidance about how to make a complaint were available and accessible to all patients who used the service.

Staff had clear responsibilities, and systems of accountability to support good governance.

Staff feedback was obtained through meetings and informal discussions. They were encouraged to offer suggestions for improvements to the service, and they said these were listened to and acted upon, where appropriate.

The practice encouraged patients to give feedback with online reviews.

The practice had taken steps to improve environmental sustainability. For example, recycling was encouraged and the implementation of digital workflow reduced transportation and material use. Staff also made sure that lights, computers and dental equipment were switched off when not in use to save energy.

The judgement for Partnerships and communities is based on the latest evidence we assessed for the Well-led key question.

The judgement for Learning, improvement and innovation is based on the latest evidence we assessed for the Well-led key question.