We carried out this announced inspection on 2 May 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 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 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

Angel Dental is in the London Borough of Enfield and provides NHS and private treatment to adults and children.

There is access for people who use wheelchairs and those with pushchairs.

The dental team includes the principal dentist, four associate dentists, six dental nurses, two hygienists, one receptionist and a practice manager.

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 inspection, we collected 21 CQC comment cards filled in by patients and spoke with two other patients.

During the inspection we spoke with the principal dentist, one associate dentists, two dental nurses and the practice manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

• Monday, Tuesday Wednesday and Friday: 9am to 5pm
• Thursday 9am to 6pm
• Saturday by appointment only

Our key findings were:

• The practice appeared clean and well maintained.
• The practice had infection control procedures which reflected published guidance.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• The practice had systems to help them manage risk.
• The provider had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• The practice had thorough staff recruitment procedures.
• 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 were providing preventive care and supporting patients to ensure better oral health.
• The appointment system took account of patients’ needs.
• The practice had effective leadership and a culture of continuous improvement.
• Staff felt involved and supported and worked well as a team.
• The practice asked staff and patients for feedback about the services they provided.
• The practice dealt with complaints positively and efficiently.
• The practice had suitable information governance arrangements.

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

• Review the practice's policy and the storage of products identified under Control of Substances Hazardous to Health (COSHH) 2002 Regulations to ensure a risk assessment is undertaken and the products are stored securely.
• Review the practice’s arrangements for receiving and responding to patient safety alerts, recalls and rapid response reports issued from the Medicines and Healthcare products Regulatory Agency (MHRA) and through the Central Alerting System (CAS), as well as from other relevant bodies, such as Public Health England (PHE).
• Review the practice’s audit protocols to ensure audits of various aspects of the service, such as infection prevention and control are undertaken at regular intervals to help improve the quality of service.

Patients expressed their views and were involved in making decisions about their care and treatment. The three patients we spoke with told us they were happy with the service they received. One patient said, "the treatment is great." Patients felt that their dignity was maintained and their privacy protected. Patient’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. One patient said, "the dentist is very helpful." We looked at three patients records. These contained a full dental history of the patients. Assessments had been carried out of the patients treatment needs. There were clear records of the treatment provided to patients.

Patients we spoke with said they were confident in the staff and service provided. There were policies and procedures in place in relation to the safeguarding of adults and children. Staff knew how to recognise safeguarding concerns and explained the appropriate action to take if they had concerns about a child or vulnerable adult.

Patients told us that the clinic was always clean. The clinic appeared clean and well maintained. There were effective systems in place to reduce the risk and spread of infection. For example, re-usable dental instruments were washed and inspected to ensure debris was removed and placed in the autoclave for sterilisation.