We undertook a focused inspection of Chartwell Dental Clinic on 29 April 2019. This inspection was carried out specifically to review the practice’s conscious sedation procedures.

The inspection was led by a CQC inspector who was supported by two dental specialist advisors, one of whom is a sedation practitioner and sedation trainer.

As part of this inspection we asked:

• Is it safe?

Background

Chartwell Dental Clinic is a dental practice situated in the town of Croxley Green in Hertfordshire. In addition to general dentistry, it provides both basic and advanced sedation techniques administered by inhalation of gases or intravenous injection, or a combination of both to children and adults.

The practice is open from 9 am to 5 pm on Monday to Friday and offers appointments on a Saturday morning once a month.

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 the practice is the principal dentist.

During the inspection we spoke with the principal dentist, the sedationist who provided conscious sedation to patients, the practice manager and one dental nurse. We looked at the practice’s procedures in relation to sedation and reviewed a sample of patients’ notes. We examined the surgeries where sedation was provided and where patients recovered following their treatment.

Our findings were:

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

There were areas where the provider could make improvements. They should:

Review the provision of conscious sedation having due regard to the Standards for Conscious Sedation in the Provision of Dental Care published by the Royal College of Surgeons in 2015.

We carried out an announced comprehensive inspection on 10 January 2017 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

Chartwell Dental Clinic is a dental practice situated in the town of Croxley Green in Hertfordshire. It occupies a commercial property and has four treatment rooms over three floors.

Chartwell Dental Clinic offers general dental treatment to adults and children funded by the NHS or privately.

In addition the practice offers conscious sedation (these are techniques in which the use of a drug or drugs produces a state of depression of the central nervous system enabling treatment to be carried out, but during which verbal contact with the patient is maintained throughout the period of sedation).

The practice utilises both basic and advanced sedation techniques in the provision of care administered by inhalation of gases or intravenous injection, or a combination of both. Conscious sedation is offered to adults and children either funded by the NHS or privately, and subject to an individual risk assessment of the patient and their needs. Patients can be referred to the practice for these services.

The practice carries out a high volume of conscious sedation cases, and treats some patients under sedation that are at greater risk of complications; such as children. For this reason the report references the newest dental conscious sedation guidance even though this has not been fully adopted by dental practices in England as yet.

The practice also accepts referrals for minor oral surgery under local anaesthetic (numbing injection) or conscious sedation.

The practice is open from 9 am to 5 pm on Monday to Friday and also offers appointments on a Saturday morning once a month.

The principal 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.

Before the inspection we sent Care Quality Commission comment cards to the practice for patients to complete to tell us about their experience. We received feedback from 14 patients. These provided a very positive view of the services the practice provides. Patients commented on the quality of care, the professional and friendly nature of staff and the cleanliness of the practice.

Our key findings were:

• The practice was visibly clean and clutter free.
• The practice was taking on NHS patients at the time of the inspection and patients could expect to be offered an appointment within a few days.
• Comments from patients indicated that the staff were kind and caring and were skilled at putting nervous patients at ease.

• A routine appointment could be secured within a few days and emergency appointments would be arranged on the day they contacted the service.

• Appointments for minor oral surgery were usually offered within a couple of weeks of referral and an appointment for conscious sedation within a month.

• The practice had policies in place to assist in the smooth running of the service.

• The practice had medicines and equipment to treat medical emergencies.
• There was appropriate equipment for staff to undertake their duties, and equipment was well maintained.
• The practice met the standards set out in national guidance regarding infection control although they had not completed an infection control audit since September 2014.
• The practice offered conscious sedation. In some aspects of the provision of care the service met the most recent guidance, however not in all aspects.

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

• Review the provision of conscious sedation in the primary care setting giving regard to guidelines published by The Intercollegiate Advisory Committee on Sedation in Dentistry in the document 'Standards for Conscious Sedation in the Provision of Dental Care 2015’. Particular reference should be made to the use of advanced sedation techniques, the treatment of children and the timing of consent.

• Review the practice’s governance protocols to monitor the completion of required risk assessments and clinical audits within the appropriate timescales.

• Review the security of prescription pads in the practice and implement systems to monitor and track their use.

• Review the practice's protocols for completion of dental records giving regard to guidance provided by the Faculty of General Dental Practice on clinical examinations, record keeping and justification and grading of X-rays taken.

• Review the practice's recruitment policy and procedures to ensure character references for new staff as well as proof of identification are requested and recorded suitably.

People we spoke with were happy with the service they had received. One person said ‘‘this is the best dentist that I have been to'’ and '‘I am certainly not frighten to come here’’. We observed the anaesthesia discuss the risk of surgical treatment and sedation and we saw that they gave the person time to ask questions. The clinic had taken reasonable measures to ensure that there were no risks of cross contamination. People were involved in the decision making process in connection to their treatment plan. The provider had a robust complaints procedure in place and complaints had been recorded and action appropriately.