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Inspection carried out on 20 December 2019

During an inspection looking at part of the service

We undertook a follow up focused inspection of Brilliant Dental Limited on 20 December 2019. 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 by a specialist dental adviser.

We undertook a comprehensive inspection of Brilliant Dental Limited on 28 October 2019 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 safe or well led care and was in breach of regulation of 12 -Safe care and treatment and Regulation 17 - Good governance under 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 Brilliant Dental Limited on our website www.cqc.org.uk.

As part of this inspection we asked:

• Is it safe?

• Is it well-led?

When one or more of the five questions are not met we require the service to make improvements.

Our findings were:

Are services safe?

We found this practice was providing safe care in accordance with the relevant regulations.

The provider had made improvements in relation to the regulatory breaches we found at our inspection on 28 October 2019.

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 found at our inspection on 28 October 2019.

Background

Brilliant Dental Limited is in the City of Westminster in London and provides private treatment to adults and children.

Car parking spaces, including some for blue badge holders, are available near the practice.

The dental team includes a dentist and a dental nurse. The practice has two treatment rooms, one of which incorporates a decontamination area.

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.

During the inspection we spoke with the dentist. We looked at practice policies and procedures and other records about how the service is managed.

Our key findings were:

  • The provider had undertaken an audit of antibiotic medicines prescribed. However, improvements were still required to ensure this information was analysed for learning.
  • The provider had carried out an audit of patient dental care records to check that necessary information was being recorded.
  • The practice was clean and the worksurfaces in the treatment rooms and the corridor were now clutter-free.
  • The practice had replaced previously missing medication from the medical emergency kit. However, improvements were required in regard to ensuring the kit had all the recommended sizes of masks for self-inflating bags.
  • We noted that work was underway to the electrics of the practice to rectify issues identified in the unsatisfactory electrical installation condition report.

  • The dentist and nurse had undertaken appropriate training including safeguarding, BLS and infection control.
  • There were appropriate recruitment procedures in place.
  • There were appropriate arrangements for the servicing of equipment used at the practice.
  • Audits had been undertaken including on Disability access, radiography and infection control.

There were areas where the provider could make improvements. They should:

  • Review the practice protocols regarding audits for prescribing of antibiotic medicines taking into account the guidance provided by the Faculty of General Dental Practice.
  • Take action to ensure the availability of equipment in the practice to manage medical emergencies taking into account the guidelines issued by the Resuscitation Council (UK) and the General Dental Council.

Inspection carried out on 28 October 2019

During a routine inspection

We carried out this unannounced inspection on 28 October 2019 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 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 not 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

Brilliant Dental Limited is located in the City of Westminster in London and provides private treatment to adults and children.

Car parking spaces, including some for blue badge holders, are available near the practice.

The dental team includes a dentist and a dental nurse. The practice has two treatment rooms, one of which incorporates a decontamination area.

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.

On the day of the inspection there were no patients to speak with. We reviewed patient feedback that patients had left about the provider.

During the inspection we spoke with the dentist. We looked at practice policies and procedures and other records about how the service is managed.

Our key findings were:

  • Improvements were required in the appearance and cleanliness of the practice.
  • The dentist generally provided patients’ care and treatment in line with current guidelines.
  • Staff were providing preventive care and supporting patients to ensure better oral health.
  • The appointment system took account of patients’ needs.
  • The provider asked staff and patients for feedback about the services they provided.
  • The dentist had some understanding of how to deal with medical emergencies. Some medicines and life-saving equipment were available on the premises.
  • Improvements were required to the provider’s infection control procedures.
  • The practice had some systems in place to help them manage risk to patients and staff.
  • The dentist was not up to date with key training such as safeguarding children and vulnerable adults and improvements were required to their safeguarding policy.
  • The provider did not have a staff recruitment procedure in place to carry out all the required recruitment checks for staff employed
  • The provider did not have systems in place to audit their non-clinical and clinical processes.

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.

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:

  • Take action to ensure the clinicians take into account the guidance provided by the Faculty of General Dental Practice when completing dental care records. In particular in regard to recording patients consent.

  • Review the practice protocols regarding audits for prescribing of antibiotic medicines taking into account the guidance provided by the Faculty of General Dental Practice.
  • Review the practice protocols regarding auditing patient dental care records to check that necessary information is recorded.

  • Review its complaint handling procedures and establish an accessible system for identifying, receiving, recording, handling and responding to complaints by service users.