We carried out an announced comprehensive inspection on 5 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

Asmile Dental Clinic Golders Green located in Golders Green provides private dental treatment to patients of all ages.

Practice staffing consists of the dentist/registered manager and one dental nurse/receptionist

The dentist 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, Tuesday and Thursdays 1pm to 6pm

The practice facilities include one treatment room, a shared reception and waiting area, decontamination room and small office area.

11 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:

• 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.
• Patients were treated with dignity and respect and confidentiality was maintained.
• 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).
• Patients received clear explanations about their proposed treatment, costs, benefits and risks and were involved in making decisions about it.
• The practice had a procedure for handling and responding to complaints, which were displayed and available to patients.
• There were systems in place to reduce the risk and spread of infection. Dental instruments were cleaned and sterilised in line with current guidance. However a legionella risk assessment had not been carried out.
• Staff had been trained to handle medical emergencies, and appropriate medicines and oxygen were readily available. However the practice did not have an automated external defibrillator (AED).
• Equipment, such as the air compressor had not been well maintained or tested for effectiveness.
• There were some governance arrangements in place for the smooth running of the practice. However the practice did not have a structured plan in place to monitor quality and safety. The practice had not effectively monitored and mitigated the risks associated with carrying out the regulated activities.
• Rubber dam was not used in all root canal treatments.

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

• Review availability of equipment to manage medical emergencies giving due regard to guidelines issued by the Resuscitation Council (UK), and the General Dental Council (GDC) standards for the dental team.
• Review the practice’s responsibilities as regards to the Control of Substances Hazardous to Health (COSHH) Regulations 2002 and, ensure all documentation is available and staff understand how to minimise risks associated with the use of and handling of these substances.
• Review the systems for checking and monitoring equipment to ensure that all equipment is well maintained.
• Review the practice’s protocols for the use of rubber dam for root canal treatment taking into account guidelines issued by the British Endodontic Society
• Review the practice’s audit protocols of various aspects of the service, such as radiography and dental care records at regular intervals to help improve the quality of service. Practice should also check all audits have documented learning points and the resulting improvements can be demonstrated.

Patients told us that they were made aware of the treatment options available to them including the cost of treatment and alternatives. We were told "they explain everything and give the options; they tell me how much it will cost and what the costs are for".

Patients using the service told us they felt safe in the hands of the dentist and dental nurse. One person explained that both he and his wife had received complex treatment from the dentist and that they felt confident and reassured through the treatment visits".

The practice's complaints procedure was clearly on display in the waiting area and people were encouraged to voice any concerns in the first instance with practice staff. One of the people spoken with commented that they had never needed to make a complaint but would feel able to raise any complaints directly with the dentist.

Patients told us that the practice “was always very clean, bright and friendly” and that staff were “professional and very knowledgeable”. One patient told us that staff always wore protective clothing when they visited and that this included gloves and masks.