Updated 15 February 2022
We carried out this announced inspection on 3 December 2021 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.
To get to the heart of patients’ experiences of care and treatment, we usually ask five key questions, however due to the ongoing pandemic and to reduce time spent on site, only the following three questions were asked:
• Is it safe?
• Is it effective?
• Is it well-led?
These questions form the main framework for the areas we look at during the inspection.
Our findings were:
Are services safe?
We found this practice was not providing safe care in accordance with the relevant regulations.
Are services effective?
We found this practice was not providing effective care in accordance with the relevant regulations.
Are services well-led?
We found this practice was not providing well-led care in accordance with the relevant regulations.
Background
Implantum Dental Practice is in Hackney in the London Borough of Tower Hamlets. The practice provides private treatments including dental implants to adult patients from a shop-front building accessed via a side entrance.
The practice is situated close to public transportation services and local amenities including supermarkets and a post office.
There is level access to the practice for people who use wheelchairs and those with pushchairs. Paid on-street parking, including dedicated spaces for people with disabilities, are available near the practice.
The building consists of two surgeries, a separate decontamination room/storage area, reception/waiting room area and a kitchenette.
The dental team includes the practice owner, one dentist and a dental nurse.
The practice is owned by a company and as a condition of registration must have a person registered with the CQC 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 inspection there was no registered manager in post as required as a condition of registration; however, an application has since been submitted. A registered manager is legally responsible for the delivery of services for which the practice is registered.
During the inspection we spoke with the practice owner, the dental nurse and the visiting compliance manager who was employed on an ad-hoc self-employed basis. The dentists was not available on the day and attempts were made to contact them after the inspection; however, we were unsuccessful. We looked at practice policies and procedures and other records about how the service is managed.
The practice is open Monday to Friday from 10am to 9pm and Saturday 10am to 6pm.
Our key findings were:
- The practice appeared to be visibly clean and well-maintained.
- Appropriate medicines and life-saving equipment were not all available on the day of inspection.
- The provider did not have effective systems to help them manage risks to patients and staff.
- The provider had safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
- The provider had staff recruitment procedures which reflected current legislation.
- Staff felt involved and supported, and worked as a team.
- The provider asked patients for feedback about the services they provided.
- There was a lack of clinical oversight and clinical staff were not providing patients’ care and treatment in line with current guidelines.
- Staff could not demonstrate they delivered preventive care and supported patients to ensure better oral health.
- Governance arrangements were ineffective.
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.
There were areas where the provider could make improvements. They should:
- 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.
- Take action to ensure dentists are aware of the guidelines issued by the British Endodontic Society for the use of rubber dam for root canal treatment.
- Improve and develop 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.