We carried out this announced inspection on 14 August 2018 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

Bupa Health and Dental Centre – West End is located in Westminster and provides private treatment to patients of all ages. The centre also provides provides GP consultations, health assessments, dermatology and musculoskeletal services. This report focused on the dental services. The report of the other services, which was inspected on the same day, can be found by selecting the ‘all reports’ link for Bupa Health and Dental Centre on our website at www.cqc.org.uk.

The practice has parking available on side roads and in nearby car parks.

The dental team includes seven dentists, five receptionists four dental nurses and a dental service manager. There were four dental treatment rooms and a decontamination room.

The practice is owned by a company and as a condition of registration must have a person registered with the Care Quality Commission as the registered manager. Registered managers 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 registered manager at Bupa Health and Dental Centre - West End Was the practice manager.

On the day of inspection, we collected 28 CQC comment cards filled in by patients.

During the inspection we spoke with two dentists, two dental nurses, two receptionists, the dental services manager and the practice manager for the medical centre the practice was based in. We looked at practice policies and procedures and other records about how the service is managed.

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 practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• The practice had 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.
• The practice was providing preventive care and supporting patients to ensure better oral health.
• The appointment system met patients’ needs.
• The practice had good leadership
• 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 systems for checking and monitoring equipment taking into account current national guidance and ensure that all equipment is well maintained.

• Review the current staffing arrangements to ensure all dental care professionals are adequately supported by a trained member of the dental team when treating patients in a dental setting considering the guidance issued by the General Dental Council.

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People gave their verbal consent to have health assessments and written consent to have exercise tests. There were arrangements in place to assess people's capacity to make the decision to have health assessments, but this had never been required.

People had a variety of tests and investigations that were performed by a health advisor and a clinical examination by a doctor. People told us that the service they received was "excellent". One person described the staff as "friendly" and "professional". Staff had attended training on protecting vulnerable adults and knew what to do in the event of concerns for a person's welfare.

The centre was clean and tidy and people said the environment was always clean. Treatment rooms were cleaned at the end of each day. Infection control audits were carried out annually and most standards were met at the last audit.

A recruitment and selection policy was in place and pre-employment checks were carried out including standard or enhanced Disclosure and Barring Service checks. Staff had an induction to the service when they started work to ensure that they were competent to perform their role.

People's records were kept both electronically and in paper form. Paper records were stored in lockable cabinets and rooms that were not accessible to unauthorised people. People's electronic records had restricted access and staff had a permission level that was appropriate to their role.

People using the service told us they felt safe in the centre and received detailed information from the provider prior to attending for their appointment. Staff treat people using the service with respect and dignity. Procedures were thoroughly explained and the practice in the centre reflected what was written on the information leaflets. Staff were professional and carried out procedures and tests safely and effectively.

We carried out an announced comprehensive inspection of Bupa Health and Dental – West End on 14 August 2018 to ask the service the following key questions; Are services safe, effective, caring, responsive and well-led?

Our findings were:

Are services safe?

We found that this service was providing safe care in accordance with the relevant regulations.

Are services effective?

We found that this service was providing effective care in accordance with the relevant regulations.

Are services caring?

We found that this service was providing caring services in accordance with the relevant regulations.

Are services responsive?

We found that this service was providing responsive care in accordance with the relevant regulations.

Are services well-led?

We found that this service was providing well-led care in accordance with the relevant regulations.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the service was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

This service was inspected in April 2013 under our previous inspection methodology and it was found at that time to be meeting all the essential standards of care.

Bupa Health and Dental Care – West End provides GP consultations, health assessments, dermatology and musculoskeletal services. This inspection focused on GP consultations, independent health assessments and dermatological procedures, including mole removal. The provider, at the same location, has an in-house dental suite offering preventive, specialist and cosmetic dental and hygienist services. The report of the dental services, which was inspected on the same day, can be found by selecting the ‘all reports’ link for Bupa Health and Dental Centre on our website at www.cqc.org.uk.

As part of our inspection, we asked for CQC comments cards to be completed by patients during the two weeks prior to our inspection. We received a total of four comments cards, all of which were positive about the service experienced. Patients commented that the service was caring and supportive and staff were professional.

Our key findings were:

• There were systems in place to safeguard children and vulnerable adults from abuse and staff we spoke with knew how to identify and report safeguarding concerns. Clinical staff had been trained to a level appropriate to their role.
• The service had systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the service learned from them and improved their processes.
• The provider carried out staff checks on recruitment, including checks of professional registration where relevant.
• Clinical staff we spoke with were aware of current evidence-based guidance and they had the skills, knowledge and experience to carry out their roles.
• There was evidence of quality improvement, including clinical audit.
• Consent procedures were in place and these were in line with legal requirements.
• Systems were in place to protect personal information about patients. The service was registered with the Information Commissioner’s Office (ICO).
• Patients could access care and treatment from the centre within an appropriate timescale for their needs.
• Information about services and how to complain was available.
• The service had proactively gathered feedback from patients.
• Governance arrangements were in place. There were clear responsibilities, roles and systems of accountability to support good governance and management.
• The provider was aware of and complied with the requirements of the Duty of Candour and encouraged a culture of openness and honesty.

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

• Review safeguarding training provided for non-clinical staff in line with guidance.
• Review the arrangements for Infection Prevention and Control (IPC) in relation to enhanced training for the IPC lead, non-clinical staff and maintaining immunisation records in line with guidance.
• Review the policy to identify and verify a patient’s identity prior to consultation.
• Review staff awareness of the interpreter service available for patients.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice