We carried out this announced inspection on 18 May 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 Care Quality Commission (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

Dental Surgery is in Orpington in the London Borough of Bromley and provides NHS and private treatment to patients of all ages.

There is level access via a ramp for people who use wheelchairs and those with pushchairs. There is parking available near the practice.

The dental team includes a practice manager, two dentists, a qualified dental nurse, a trainee dental nurse, and a receptionist. The practice has two treatment rooms.

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 obtained feedback from 44 patients.

During the inspection we spoke with the principal dentist, the qualified dental nurse, and the practice manager. We checked practice policies and procedures and other records about how the service is managed.

The practice is open Monday to Friday from 9am to 1pm, and from 2pm to 5pm. They are closed for lunch between 1pm and 2pm.

Our key findings were:

• The practice appeared clean and well maintained.
• The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• 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.
• 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.
• The practice had effective leadership and a culture of continuous improvement.
• Staff knew how to deal with emergencies.
• Appropriate medicines and life-saving equipment were available in line with current national guidance.
• The practice had systems to help them manage risk, though the fire risk assessment had not been completed by a competent person. The health and safety risk assessment also required a review.
• The practice’s infection control protocols generally reflected published guidance; they had carried out infection control audits yearly instead of six monthly as recommended in current national guidance.

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

• Review the practice's environmental risk assessments with regard to reviewing the health and safety risk assessment, and ensuring a fire risk assessment is undertaken by a competent person and any necessary actions implemented.
• Review the practice’s infection control protocols, considering guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices to ensure infection control audits are completed every six months.

Dental Surgery is located in the London Borough of Bromley in south-east London and provides mostly NHS dental services.

We carried out an announced comprehensive inspection on 20 January 2015. The inspection took place over one day and was undertaken by a CQC inspector. We looked at policy documents, dental care records, spoke with a patient and staff including the management team.

The practice team included a principal dentist, one associate dentist, two dental nurses, a dental hygienist and a reception manager. The services provided include mainly general dentistry such as placement of crowns, dentures and fillings.

We received 17 CQC comment cards completed by patients, and spoke with a patient on the day of the visit. The feedback we received rated the practice highly.

Our key findings were:

• Patients’ needs were assessed and care was planned and delivered in line with current guidance such as that from the National Institute for Health and Care Excellence (NICE) and other published guidance.

• Staff had received training appropriate to their roles.

• All comment cards we reviewed indicated that patients were happy and satisfied with the care they received.

• Staff told us they felt well supported and that they were committed to providing a quality service to their patients.

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

• Ensure incidents and significant events are discussed and learning shared amongst staff.
• Ensure all staff receive regular performance reviews and annual appraisals.
• Ensure all relevant recruitment checks are undertaken before staff commence their job at the practice.

• Ensure the temperature of the refrigerator used to store medicines and dental products is monitored and recorded daily.
• Ensure regular audits are undertaken of dental care records to check quality and appropriateness of recorded data.
• Ensure staff induction check-list includes awareness of infection control procedures.
• Ensure a fire risk assessment of the building is available.