We carried out an announced comprehensive inspection on 31 March 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

Antwerp House Dental Practice is one of seven practices owned by Mr Raj Wadhwani and provides both private and NHS funded dental services to adults and children. In addition to general dentistry, it offers a range of procedures including dental implants, teeth whitening, facial aesthetics and anti-snoring devices. It also offers conscious sedation to very nervous patients.

The practice employs 38 full and part-time staff. This includes eight dental surgeons, five hygienists and 11 dental nurses. A range of dental specialists also visit to provide treatment including periodontists, endodontists and orthodontists. They are supported by a number of administrative and reception staff.

The practice opens from 8am to 6.30pm on a Monday; from 8am to 5pm on Tuesdays, Wednesdays and Fridays; and from 8am to 6pm on a Thursday. It is also opens on a Saturday from 8am until 4 pm. The premises consist of ten treatment rooms, two patient waiting areas, a decontamination room and various staff offices.

We spoke with three patients during our inspection and also received 19 comments cards that had been completed by patients prior to our inspection. All the comments received reflected that patients were very satisfied with the staff, the explanation of their treatment and the quality of the dentistry provided.

Our key findings were:

• We received consistently good feedback from patients about the quality of the practice’s staff and the effectiveness of their treatment.

• The practice had effective safeguarding processes in place and staff understood their responsibilities for safeguarding adults and children.
• Patients’ care and treatment was planned and delivered in line with evidence based guidelines, best practice and current legislation. Patients’ dental care records provided an accurate, thorough and contemporaneous record of their care, consent and treatment.
• The practice placed an emphasis on the promotion of good oral health.
• The premises were clean and well maintained.

• Infection control and decontamination procedures were robust, ensuring patients’ safety.
• Staff had received training appropriate to their roles and were supported in their continued professional development.
• The practice had a comprehensive schedule of clinical audit demonstrating a commitment to continuous improvement.

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

• Review the use of CCTV cameras to ensure it meets guidance as set out in the Information Commissioner’s’ Office; In the picture: A data protection code of practice for surveillance cameras and personal information.

• Provide signage to indicate the area where oxygen is stored, and where emergency medical equipment can be found.
• Implement the recommendations of the practice’s Legionella assessment.
• Obtain staff references prior to their employment and keep a record of recruitment interviews.
• Review the practice’s protocols for conscious sedation, giving due regard to 2015 guidelines published by The Intercollegiate Advisory Committee on Sedation in Dentistry in the document 'Standards for Conscious Sedation in the Provision of Dental Care 2015, ensuring that patients’’ blood pressure is monitored.
• Service and maintain all equipment used for conscious sedation.
• Ensure that all staff receive regular appraisal of their working practices
• Undertake regular checks of dental clinicians’ professional registration.

• Cover and protect loose medical items such as local anaesthetics in treatment room drawers.
• Review the storage of medicines requiring refrigeration to ensure they are stored in line with the manufacturer’s guidance and the fridge temperature is monitored and recorded.

People we spoke with told us they were satisfied with the information provided about their treatment and they had discussed their needs and planned their care and treatment with the dentist. They told us they had been treated with respect by all the staff employed by the practice.

We found the records of people's treatment were accurate and detailed, apart from the updates that should have been recorded regarding people's health and medication. These two recordings, on the computer held care and treatment plans, had not been updated at each appointment that people had attended. This meant that it was not certain whether the dentist had enquired, or was informed about these aspects of a person's health.

Cleanliness and risks of cross infection were minimized and managed by staff who carried out appropriate and suitable decontamination of used surgical instruments.

The total refurbishment of the premises was being managed in a way that ensured the building remained clean and safe. Work had been scheduled to take place after hours, so that there was not any disruption, or an unsafe environment during the practice's opening times.