We carried out an announced comprehensive inspection of this service on 29 February 2016 as part of our regulatory functions where a breach of legal requirements was found.

After the comprehensive inspection the practice wrote to us with an action plan to say what they would do to meet the legal requirements in relation to the breach.

We revisited Arundel Lodge Dental Surgery Ltd for a follow-up inspection on 8 February 2017 to check that they had followed their plan and to confirm that they now met the legal requirements.

We reviewed the practice against one of the five questions we ask about services: is the service 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 Arundel Lodge Dental Surgery on our website at www.cqc.org.uk.

We carried out an announced comprehensive inspection on 29 February 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 not providing well-led care in accordance with the relevant regulations.

Background

Arundel Lodge Dental Surgery is located in Dorking, Surrey. The premises are situated in a quiet residential road off the High Street and consist of a ground floor and a basement. There are two treatment rooms, an X-ray room, a reception area and a patient toilet on the ground floor. There is a storage room, staff room and toilet in the basement.

The practice provides mainly private services to adults and children and has a small NHS list for children. The practice offers a range of dental services including routine examinations and treatment, veneers and crowns and bridges.

The practice staffing consisted of one principal dentist (who was also the provider), one visiting dentist who provides dental implants, one dental hygienist, one trainee dental nurse, one qualified dental nurse and two receptionists.

The practice is open Monday and Thursday 9:00am to 7:00pm, Tuesday and Friday 8:30am to 5:00pm and closed on Wednesday.

The principal dentist is registered with the Care Quality Commission (CQC) as an individual provider. 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 inspection took place over one day and was carried out by a CQC inspector and a dental specialist advisor.

Before the inspection we sent Care Quality Commission (CQC) comments cards to the practice for patients to complete to tell us about their experience of the practice. Twenty-one patients provided feedback about the service. Patients were positive about the care they received from the practice. They were complimentary about the friendly and caring attitude of the dental practice team.

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).

• There were effective systems in place to reduce and minimise the risk and spread of infection.
• The practice had effective safeguarding processes in place and staff understood their responsibilities for safeguarding adults and children living in vulnerable circumstances however staff must complete formal training.
• Equipment, such as the air compressor, autoclave (steriliser), fire extinguishers, and X-ray equipment had all been checked for effectiveness and had been regularly serviced.
• Patients indicated they felt they were listened to and that they received good care from a helpful and caring practice team.
• The practice had not ensured staff maintained the necessary skills and competence to support the needs of patients. For example staff had not completed training in safeguarding.
• The staff told us they were well supported by the provider and felt listened to if they raised any concerns.
• Governance arrangements and audits were not always effective in improving the quality and safety of the services.

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

• Ensure there are robust processes for reporting, recording, acting upon and monitoring significant events and learning points are documented and shared with all relevant staff.
• Ensure that all practice risk assessments are updated and accurately reflect potential hazards to both patients and staff and comply with the Control of Substances Hazardous to Health 2002 (COSHH) regulations.
• Ensure the training, learning and development needs of staff members are reviewed and recorded at appropriate intervals including areas such as infection control, safeguarding and radiography. Establish and ensure an effective process for the on-going assessment and supervision of all staff employed.
• Ensure audits of various aspects of the service, such as infection control and dental care records are undertaken at regular intervals to help improve the quality of service provided and record keeping in accordance with the Faculty of General Dental Practice (FGDP). The practice should also ensure all audits have documented learning points and the resulting improvements can be demonstrated.

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

• Review its responsibilities to meet the needs of patients with a disability and the requirements of the Equality Act 2010 and ensure a Disability Discrimination Act 1995 audit is undertaken for the premises.

Ensure dental care records are maintained appropriately giving due regard to guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.

People who used the service told us that they were provided with good information about treatment options and the associated costs and were able to ask questions if they didn’t understand something. People told us they felt they had enough time and information to make decisions about their treatments. Comments included; "The dentist will take the time to explain to me what treatment I need", "They always talk you through what is happening" and "I get a written treatment plan that tells me about my treatment and what it costs". People told us that staff were "Friendly" "Professional" and "Helpful". People said they were treated with respect and their privacy was protected. People told us that they thought the service was "Excellent". They also told us "The staff will put you at ease here, the dental practitioner is very courteous and gentle". People said that the appointment system worked well and that the service was clean and comfortable.