We carried out this announced inspection on 15 August 2017 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.

We told the NHS England area team and Healthwatch that we were inspecting the practice. We did not receive any information from them.

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

Cavendish Dental Practice is located in East Finchley in the London Borough of Barnet. The practice provides predominantly private dental treatment to patients of all ages. The practice has a small NHS contract to treat children.

There is level access for people who use wheelchairs and those with pushchairs.

The dental team includes two dentist partners four associate dentists, three dental hygienists, six dental nurses, two receptionists and a practice manager. The practice has three treatment rooms.

The practice is owned by a partnership 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 Cavendish Dental Practice is one of the dental partners.

We received feedback from 34 patients via CQC comment cards and speaking with patients. This information gave us a positive view of the practice.

During the inspection we spoke with both principal dentists, one associate dentist, two dental nurses, and one receptionist. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open between 8.30am and 5.30pm on Mondays to Fridays and between 9am and 4.30pm on Saturdays.

Our key findings were:

• The practice was 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 thorough 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 appointment system met patients’ needs.
• The practice had effective 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.

During our inspection on 25 June 2013 we found non-compliance with cleanliness and infection control. For example, the frequency of the audit test decontamination processes was not compliant with the Department of Health’s Health Technical Memorandum (HTM01-05) guidance and the infection control and decontamination leads within the practice were not clear. The provider submitted an action plan to address areas of non-compliance.

At this inspection we did not speak to patients, but we observed that the surgery was clean and noted the improvements made by the provider. We found that the dentist had made a number of improvements to their infection control processes. There was a dedicated infection control lead and a lead infection control nurse to ensure that audits were taking place and staff were trained to deliver the decontamination and infection control requirements as set out in HTM01-05.

People experienced care, treatment and support that met their needs. A person who used the practice told us “I love my dentist.”

There were arrangements in place in case a person using the service collapsed at the surgery. This included staff having the training to support the patient and a supply of medication and equipment.

We saw that the practice appeared clean. People we spoke with said “yes, it’s very clean”. The practice had a separate decontamination room, in line with best practice. However, we observed that two sinks or the equivalent were not used for cleaning and rinsing instruments and detergent was not used. Regular tests of decontamination equipment took place but the six monthly audit of decontamination processes had been carried out annually, and not since January 2013.

There was no clearly designated infection control lead in the surgery. This meant there was a risk of standards of infection control not being maintained. The role of the registered manager was not clear and CQC had not been informed who this was.

The practice had systems in place to assess and monitor the quality of the service they offered.