The Care Quality Commission
  • Dentist
  • Dentist

Dental Harmony

1 Seven Ways Parade, Woodford Avenue, Gants Hill, London, Essex, IG2 6XH

Provided and run by:
Dental Harmony Ltd

All Inspections

15 December 2020

During an inspection looking at part of the service

We undertook a follow up inspection of Dental Harmony on 15 December 2020. This inspection was carried out to assess 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 had remote access to a specialist dental adviser.

We undertook a comprehensive inspection of Dental Harmony on 20 February 2020 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 Regulations 12, 17and 18 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 Dental Harmony on our website www.cqc.org.uk.

As part of this review 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 and send us an action plan. We then review this information after a reasonable interval, focusing on the area where improvement was required.

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 breach we found at our inspection on 20 February 2020.

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 20 February 2020.

Background

Dental Harmony is in Gants Hill in the London Borough of Redbridge and provides private dental care and treatment for adults and children.

The practice is located on the ground floor and has two treatment rooms. There is level access to the practice for people who use wheelchairs and those with pushchairs.

The practice is located close to public transport links.

The dental team includes the registered manager, three dentists, one specialist oral surgeon, three trainee dental nurses and two receptionists.

The practice is owned by an organisation and as a condition of registration must have a person registered with the Care Quality Commission 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. The registered manager at Dental Harmony is one of the owners.

During the inspection we spoke with the practice owner, one trainee dental nurse and the receptionist. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open between

Mondays to Fridays 10.00 am to 8.00 pm

Saturdays 9.00 am to 6.00 pm

Our key findings were:

Improvements had been made to the systems for:

  • assessing and managing risks to patients.
  • ensuring up-to-date documentation relating to staff recruitment and training was available.
  • monitoring patient referrals.
  • managing medicines safely.
  • ensuring single-use items were disposed of appropriately and not re-used.
  • managing risks associated with the Control of Substances Hazardous to Health (COSHH) Regulations 2002.

Systems and arrangements were now in place to:

  • monitor the use-by dates of all dental materials.
  • ensure the effective decontamination of dental instruments.
  • ensure that all clinical staff had adequate immunity against vaccine preventable infectious diseases.

  • ensure that staff undertook suitable training, relevant to their roles and responsibilities including practical training in dealing with medical emergencies and infection control.
  • support and monitor trainee dental nurses to carry out their role effectively.
  • check and monitor equipment taking into account relevant guidance to ensure that all equipment was well maintained.

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

  • Review the practice’s protocols for the use of closed circuit television cameras taking into account the guidelines published by the Information Commissioner's Office.

20 February 2020

During a routine inspection

We carried out this unannounced inspection on 20 February 2020 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 this practice was not providing safe care in accordance with the relevant regulations.

Are services effective?

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

Are services caring?

We found this practice was providing caring services in accordance with the relevant regulations.

Are services responsive?

We found this practice was providing responsive 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

Dental Harmony is in Gants Hill in the London Borough of Redbridge and provides private dental care and treatment for adults and children.

The practice is located on the ground floor and has two treatment rooms. There is level access to the practice for people who use wheelchairs and those with pushchairs. Car parking spaces are available in surrounding roads and the practice is located close to public transport links.

The dental team includes the registered manager, three dentists, one specialist oral surgeon, three trainee dental nurses and two receptionists.

The practice is owned by an organisation and as a condition of registration must have a person registered with the Care Quality Commission 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. The registered manager at Dental Harmony is one of the owners.

During the inspection we spoke with one dentist, two trainee 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:

Mondays to Fridays 10am to 8pm

Saturdays 9am to 6pm

Our key findings were:

  • The practice appeared to be visibly clean and well-maintained.
  • 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.
  • Staff provided preventive care and supported patients to ensure better oral health.
  • The appointment system took account of patients’ needs.
  • Staff felt involved and supported and worked as a team.
  • The provider had safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
  • Staff knew how to deal with emergencies. Emergency equipment and medicines however, were not available as described in recognised guidance..
  • The provider had some systems to help them manage risk to patients and staff; however, improvements were needed to consider all appropriate risks and ensure the risk assessments carried out accurately reflect the current systems in place.
  • The provider had an infection control policy which reflected published guidance. However, the decontamination of used dental instruments was not carried out in accordance with this policy and staff did not follow current guidelines.
  • The practice did not have effective arrangements for the safe use of medicines and equipment. Improvements were needed to ensure out of date materials were disposed of appropriately and medicines were stored and dispensed according to current guidelines. Systems were also required to ensure single-use items were not re-used.
  • The provider had staff recruitment procedures which reflected current legislation. However, improvements were needed to ensure the procedure was followed and checks were carried out consistently for all staff.
  • There was ineffective leadership and a lack of general oversight for the day-to-day running of the service.

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 and supervision necessary to enable them to carry out their duties

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.
  • Implement an effective system for monitoring and recording the fridge temperature to ensure that medicines and dental care products are being stored in line with the manufacturer’s guidance.
  • Improve and develop staff awareness of the requirements of the Mental Capacity Act 2005 and Gillick competency and ensure all staff are aware of their responsibilities under the Act as it relates to their role.

14 July 2017

During an inspection looking at part of the service

We carried an unannounced focused follow up inspection on 14 July 2017 at Dental Harmony.

We had undertaken an announced comprehensive inspection of this service on 31 January 2017 as part of our regulatory functions where breaches of legal requirements were found.

After the inspection, the practice wrote to us to say what they would do to meet the legal requirements in relation to the breaches.

We revisited Dental Harmony as part of this review and checked whether they had followed their action plan.

We reviewed the practice against one of the five questions we ask about services:

  • Is it well-led?

This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection by selecting the 'all reports' link for Dental Harmony on our website at www.cqc.org.uk.

Background

This inspection was planned to check whether the practice was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The follow up inspection was carried out by a CQC inspector who had access to remote advice from a specialist advisor.

During our inspection visit, we checked that points described in the provider’s action plan had been

implemented by looking at a range of documents such as risk assessments, policies, procedures and staff training. We also spoke with staff and carried out a tour of the premises.

Our key findings were:

  • Systems were in place to assess, monitor and improve the quality of the service
  • The practice had systems to help them manage risk.
  • Equipment was maintained and serviced in line with the manufacturer’s instructions.
  • The practice had infection control procedures which reflected published guidance.
  • The practice had policies and procedures to underpin the day to day management of the service and there were arrangements to ensure that these were understood and followed.

30 January 2017

During a routine inspection

We carried out an announced comprehensive inspection on 30 January 2017 to ask the practice the following key questions; Are services safe, effective, caring, responsive and well-led?

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

Dental Harmony in Gants Hill London provides private dental treatment to patients of all ages. The provider told us that the patients visiting the practice were predominantly from the Lithuanian and Russian community.

Practice staffing consists of four associate dentists, orthodontic therapist, oral surgeon, orthodontist, two trainee dental nurses, two administrators and a practice manager.

The practice owner is the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the practice is run.

The practice is open Monday to Friday 10am to 8pm and Saturday 9am to 6pm

The practice facilities include two treatment rooms a decontamination room, reception/waiting area, and a staff room/kitchen.

15 patients provided feedback about the service. Patients who completed comment cards were very positive about the care they received from the service. Patients told us that they were happy with the treatment and advice they had received.

Our key findings were:

  • Patients’ needs were assessed and care was planned in line with current guidance such as from the National Institute for Health and Care Excellence (NICE).
  • The practice sought feedback from patients about the services they provided and acted on this to improve its services.
  • The practice had a procedure for handling and responding to complaints, which were displayed and available to patients.
  • Equipment, such as the autoclaves, fire extinguishers and compressor had all been checked for effectiveness and had been regularly serviced.
  • Patients received clear explanations about their proposed treatment, costs, benefits and risks and were involved in making decisions about it.
  • Patients were treated with dignity and respect and confidentiality was maintained.
  • Not all clinical staff had been trained to handle medical emergencies and not all recommended medicines and life-saving equipment were readily available.
  • Infection control protocols were not being followed in line with recommended national guidance.
  • The practice had not ensured that all the specified information relating to persons employed at the practice was obtained and appropriately recorded.
  • Governance systems were not effective. The practice had not carried out radiography audits. The practice had carried out limited risk assessments to safeguard the health and safety of staff and patients.
  • Not all staff had received safeguarding children and adults training; however staff knew the processes to follow to raise any concerns. The practice had whistleblowing policies and procedure and staff were aware of these and their responsibilities to report any concerns.
  • Improvements could be made to ensure dental care records were being suitably completed in line with guidance provided by the Faculty of General Dental Practice.

We identified regulations that were not being met and the provider must:

  • Ensure an effective system is established to assess, monitor and mitigate the various risks arising from undertaking of the regulated activities.
  • Ensure systems are in place to assess, monitor and improve the quality of the service. This could include for example undertaking regular audits of various aspects of the service and ensuring that where appropriate audits have documented learning points and the resulting improvements can be demonstrated.
  • Ensure the practice's recruitment policy and procedures are suitable and the recruitment arrangements are in line with Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 to ensure necessary employment checks are in place for all staff and the required specified information in respect of persons employed by the practice is held.
  • Ensure staff training and availability of medicines and equipment to manage medical emergencies giving due regard to guidelines issued by the British National Formulary, the Resuscitation Council (UK), and the General Dental Council (GDC) standards for the dental team.
  • Ensure systems are put in place for the proper and safe management of medicines.
  • Ensure the practice undertakes a Legionella risk assessment and implements the required actions giving due regard to guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices and The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance’

You can see full details of the regulations not being met at the end of this report.

There were areas where the provider could make improvements and should:

  • Review the practice’s infection control procedures and protocols taking into account guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices and The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance’
  • Review the practice’s safeguarding training ensuring it covers both children and adults and all staff are trained to an appropriate level for their role and aware of their responsibilities.
  • 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 giving due regard to the Ionising Radiation (Medical Exposure) Regulations (IR(ME)R) 2000.
  • Review the practice's protocols for completion of dental records giving due regard to guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.

29 September 2014

During an inspection looking at part of the service

Care and treatment was planned and delivered in a way that was intended to ensure patient's safety and welfare. The provider had implemented the necessary procedures to enable them to deal with emergencies effectively.

Patients were protected from the risk of infection because appropriate guidance had been followed. People were cared for in a clean, hygienic environment.

The provider had an effective system to regularly assess and monitor the quality of service that people receive. There was an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others.

15 May 2014

During an inspection in response to concerns

People told us treatment options and procedures were clearly explained to them, and they were able to ask questions about anything they did not understand. Comments included "the treatment was explained, I asked quite a few questions and I understood" and "they explained what they were doing and gave me advice". People said they were treated with dignity and respect by all staff and their privacy and confidentiality was maintained.

People's needs were assessed and care and treatment was planned and delivered in line with their individual treatment plan. Those we spoke with said they were happy with the care and treatment they received. Comments included "they're very good" and "I will definitely return here". We found the provider did not have suitable procedures in place for dealing with emergencies.

The premises were visibly clean. People were satisfied with the cleanliness of the environment and the hygiene practices of staff. Comments included "the hygiene is spot on. I saw them wearing gloves and masks" and "yes, I am happy with the hygiene. It's very clean".

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

The quality of the service provided was not being regularly assessed and monitored. This placed people at risk of inappropriate and unsafe care and treatment.