We carried out an announced comprehensive inspection on 25 July 2016 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 providing well-led care in accordance with the relevant regulations

Background

AG Dentistry - Kentish Town located in Camden provides NHS and private dental treatment to patients of all ages.

Practice staffing consists of the two principal dentists, two practice managers, two dentists, one hygienist, two dental nurses and one receptionist.

One of the principal dentists has applied to be 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 9am to 6pm and Saturday 10am to 2pm.

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

12 patients provided feedback about the service. Patients we spoke with and those who completed comment cards were very positive about the care they received about 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).
• We found the dentists regularly assessed each patient’s gum health and took X-rays at appropriate intervals.
• The practice ensured staff were trained and that they maintained the necessary skills and competence to support the needs of patients.
• Staff had received safeguarding children and adults training and 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.
• There were systems in place to reduce the risk and spread of infection. Dental instruments were cleaned and sterilised in line with current guidance.
• Equipment, such as the autoclaves, fire extinguishers, and X-ray equipment 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.
• Patients had good access to appointments, including emergency appointments, which were available on the same day
• The practice sought feedback from staff and patients about the services they provided and acted on this to improve its services.
• Governance systems were effective and there were a range of policies and procedures in place which underpinned the management of the practice. Clinical and non-clinical audits were carried out to monitor the quality of services.

At the inspection in January 2013 we found that the provider did not have effective systems in place to support workers due to the lack of a formal appraisal system. This meant that staff were not appropriately supported to enable them to deliver care and treatment to patients safely as they did not receive appropriate supervision and appraisal. (Regulation 23(1)(a))

We also found that clinical audits were not being fully documented. This meant that people were not adequately protected against the risks of inappropriate or unsafe care and treatment as the provider did not have a system in place to regularly assess and monitor the quality of services provided. (Regulation 10(1)(a)).

At the follow up inspection we found that a staff appraisal system had been put in place to support staff which was complimented by a monthly staff meeting to discuss current issues as a full staff team.

A full audit system was in place and appropriately documented and any actions discussed in staff meetings and followed up.

We spoke with seven patients who all gave positive feedback about the care and treatment they had received. One patient told us "The dentist is excellent, really helpful and kind. I am a nervous patient and the staff are always kind, caring and reassuring."

We observed care being delivered to five patients and saw they were treated with dignity and respect. Patients told us that they were given a copy of the treatment and costs involved and given time to think before undergoing treatment.

We observed staff speaking to patients politely both at the practice and over the telephone and found they were happy to answer questions. We found that records relating to patients were kept securely ensuring confidentiality.

Infection prevention and control was effectively carried out in accordance with guidance from the Department of Health. Patients we spoke with were positive about the cleanliness of the practice telling us "The place is always clean. I am always given a bib and glasses.”

We found staff were supported in their professional development and encouraged to take part in additional training however they were not supported by a system of formal appraisal.

The provider took account of complaints and comments to improve the service. We found overall however, that the provider did not have an effective system in place to continuously monitor and improve the quality of service provision.