We carried out an announced comprehensive inspection on 21 October 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

Care Dental is located in The London Borough of Tower Hamlets and provides private and NHS dental services. The opening hours for the practice were Monday to Friday 10.00 to 18.00.

The premises consist of one treatment room, a decontamination room and a waiting and reception area for patients.

The practice comprises of two principal dentists, two nurses and one receptionist.

One of the principal dentists is registered with the Care Quality Commission (CQC) as an individual registered person. 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.

During the inspection we asked patients to complete CQC comment cards. We received five completed comment cards. The patients who provided feedback were positive about the care and treatment they received at the practice. They told us they were involved in all aspects of their care and found the staff to be caring, friendly and helpful and they were treated with care, dignity and respect.

Our key findings were:

• There were effective processes in place to reduce and minimise the risk and spread of infection.
• 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 were involved in their care and treatment planning.
• There was appropriate equipment for staff to undertake their duties and equipment was well maintained.
• Staff were trained in and there was appropriate equipment for them to respond to medical emergencies.
• Patients told us that staff were caring and treated them with dignity and respect.
• Patients indicated that they felt they were listened to and that they received good care from a helpful and caring practice team.
• There were processes in place for patients to give their comments and feedback about the service including making complaints and compliments.
• Improvements were required to ensure recruitment checks were undertaken suitably before employing staff.

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

Review staff training to ensure that all of the staff had undergone relevant training, to an appropriate level, in the safeguarding of children and vulnerable adults.

• Review the practice’s infection control procedures and protocols taking into account guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices and The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related Guidance.

• Review staff awareness of the requirements of the Mental Capacity Act (MCA) 2005 and ensure all staff are aware of their responsibilities under the Act as it relates to their role.

• Review the practice’s protocols for completion of the patients’ dental care records taking into account guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.
• Review the protocol for completing accurate, complete and detailed records relating to employment of staff. This includes ensuring recruitment checks are suitably obtained and recorded.

We carried out this inspection to check that the provider had taken action to become compliant with essential standards following an earlier inspection in March. We found that the provider had taken appropriate actions. The dentists had made changes to their record keeping and were ensuring that they checked people's medical history at each consultation. We also found that all the emergency medicines were in date and stored appropriately. The staff were able to demonstrate they were following national guidance to ensure that instruments were properly sterilised and safe for use. We reviewed a range of clinical and practice records during our inspection and found these were accurate and accessible when required.

We spoke to two people who used the service and both were complimentary about the practice. They commented "The staff are good and friendly". The other said "The staff are really nice and I recommend the practice to my friends". They both felt that they were well informed about the choices, the cost and possible outcomes of their treatment.

We saw that there were some areas where the practice management and systems were poor. There had been a failure to update the practice to comply with current regulations and a failure to address issues highlighted by other external agencies. We found people’s medical histories were not fully assessed and documented in their records and emergency drugs were not all in date and fit for use. People were not protected from the risk of infection because appropriate guidance had not been followed. Records relevant to the management of the service were not available.