We carried out this announced inspection on 11 July 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

Cheam Dental Practice is in North Cheam, in the London Borough of Sutton and provides NHS and private treatment to adults and children.

There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces are available at the practice as well as unrestricted parking on surrounding roads. Local bus routes are also available.

The dental team includes three dentists, two dental nurses (one of whom is also the practice manager), a trainee dental nurse, two dental hygienists, and a receptionist. The practice has three treatment rooms, a decontamination room, an office and a staff room.

The practice is owned by an individual who is the principal dentist there. They have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run.

On the day of inspection, we collected comments from 43 patients through CQC comment cards filled in by patients and speaking with patients.

During the inspection we spoke with two dentists, two dental nurses, and the practice manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open: 8.30am to 5.30pm Monday to Fridays. The practice closes between 1.00pm and 2.00pm for lunch.

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. Some staff had not received recent training in medical emergencies.
• The practice had systems to help them manage risk, although improvements were required around the frequency of completing risk assessments.
• 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 practice was providing preventive care and supporting patients to ensure better oral health.
• The appointment system met patients’ needs.
• The practice had effective leadership and culture of continuous improvement.
• 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.

Full details of the regulation/s the provider was/is not meeting are at the end of this report.

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

• Review staff training to manage medical emergencies taking into account the guidelines issued by the Resuscitation Council (UK) and the General Dental Council.
• Review the practice’s systems for assessing, monitoring and mitigating the various risks arising from the undertaking of the regulated activities. In particular, arrangements in place for assessing fire safety procedures and risk assessments and the frequency of completing risk assessments
• Review the practice's complaint handling procedures and establish an accessible system for receiving, recording, handling and responding to complaints by service users.

We spoke with five patients and four members of staff.

Patients told us, "they talk you through everything they do. They definitely listen to you" and "they respect your wishes and choices." We found evidence that the practice made adjustments for people who were disabled or did not speak English.

We found that staff were trained in dealing with medical emergencies and there were emergency drugs and oxygen on site. Patients told us staff checked their medical history at each visit and we found evidence of this. One patient said, "they take my medication into account." Other patients said, "I'm very happy with the treatment" and "they help you relax."

Patients said they felt standards of cleanliness and hygiene were adequate and we found evidence that appropriate infection control and decontamination guidance had been followed.

We found that staff were supported to access relevant training, professional development and staff meetings. Staff told us they felt supported in their roles.

The practice was a member of a "good practice" scheme and we found other evidence that the provider had systems to regularly assess and monitor the quality of the service provided. Patients were invited to complete feedback forms and we found the feedback was positive.