We carried out this announced inspection on 16 October 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 that we were inspecting the practice. They did not provide any information which we took into account.

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

Confident Dental Practice is in Wimbledon and provides mainly private and some NHS treatment to patients of all ages.

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

The dental team includes five dentists, three dental nurses, two dental hygienists, two dental hygienist therapists, two receptionists and a practice manager. The practice has four treatment rooms and a decontamination room.

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. At the time of the inspection the practice did not have a registered manager in post. We discussed this with the principal dentists and they told us one would be appointed soon.

On the day of inspection we collected 27 CQC comment cards filled in by patients. This information gave us a positive view of the practice.

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

The practice is open: Monday to Fridays from 9.00am to 5.30pm. They also offered extended opening for private patients as follows:

Monday – 5.30pm to 6.00pm

Tuesday 8.00am to 9.00am

Wednesday 5.30pm to 8.00pm

Alternative Saturdays from 9.00am to 1.00pm.

Our key findings were:

• The practice generally clean although some areas were showing signs of being worn and in needs of deep cleaning
• Infection control procedures which reflected published guidance.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available (including a defibrillator which had been ordered but not delivered at the time of the inspection).
• The practice had systems to help them manage risk, although some of the risk assessments were out of date.
• Staff we spoke with knew their responsibilities for safeguarding adults and children. However the practice safeguarding policies and procedures lacked detail and needed reviewing.
• 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 appointment system met patients’ needs. However information provided to patients about appointments needed improving.
• 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.

We found areas where the provider could make improvements and should:

• Review the staff supervision protocols and ensure an effective process is established for the on-going appraisal of all staff

We spoke with several people who use the service. People spoke highly of the dentist and the team, and felt that they were treated well. One person told us “the dentist has a good bedside manner. They listen to what I have to say”. Another person told us “I am very pleased with all the care and treatment I receive”. They said they felt the premises were clean and comfortable and referred to staff as friendly and always helpful.

People informed us the dentist always provided detailed information on treatments and costs and explained their treatment needs and options to them. People told us that they knew how to make a compliant or express concern if they needed to.

We looked at records for the patient satisfaction questionnaires that are conducted on an annual basis. Comments written about the service were positive with many comments being made about the supportiveness of staff. The service also operated a comments and suggestions box which was located in the waiting area and was checked frequently by the receptionist.

We observed that there were effective systems in place to reduce the risk of the spread of infection. The premises were clean and easily accessible to all including disabled toilet facilities.

People’s views and experiences were taken into account in the way the service was provided and delivered and there were effective systems in place to regularly assess and monitor the quality of service that people receive.

People who use the service told us that reception staff were very helpful and made them feel at ease. The dentists and dental nurses were very friendly and welcoming, they received thorough examinations and everything including their treatment and the cost of treatment was explained to them. They told us they knew how to make a complaint if they needed to. They told us they were able to make appointments when needed.

They told us their privacy and confidentiality was respected and the practice was always clean and tidy.

One person told us “I have been using the practice for about three years and I’m very satisfied with the treatment I have received”. Another person told us “I’m happy with the practice and when I come here everything is fine and dandy”.