We carried out this announced inspection on 27 February 2019 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

Dr S D Springate - Orthodontic Practice is in Westminster and provides private orthodontic treatment to adults and children.

There is access for people who use wheelchairs and those with pushchairs via a ramp and a lift. Car parking spaces are available at a fee on nearby roads.

The dental team includes a dentist, and a dental nurse. The practice also employed two administrative members of staff. The practice has one treatment room that incorporates the decontamination facilities.

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 received feedback from 23 patients.

During the inspection we spoke with the dentist and the nurse. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open: Tuesday, Wednesday, Friday 10:30am to 6:00pm.

Our key findings were:

• The practice appeared clean and well maintained.
• The practice had infection control procedures which reflected published guidance. However, some improvements were required.
• 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 staff 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. However, some improvements were required in regard to the frequency of some audits.
• 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.

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

• Review staff awareness of the requirements of the Mental Capacity Act (MCA) 2005 and ensure all staff are aware of their responsibilities under the Act as it relates to their role.
• Review the practice’s audit protocols to ensure audits of various aspects of the service, such as infection prevention and control are undertaken at regular intervals to help improve the quality of service. Practice should also ensure, that where appropriate audits have documented learning points and the resulting improvements can be demonstrated.

• Review the practice's protocols for monitoring and recording the fridge temperature to ensure that medicines and dental care products are being stored in line with the manufacturer’s guidance.

We spoke with two people on the day of our visit. People we spoke with said they were "very happy" with the doctor. They felt the care and treatment given was "marvellous" and the doctor was "very reassuring, patient and gentle" when giving treatment. People confirmed they had treatment plans and that they were making informed decisions.

There were effective systems in place to reduce the risk and spread of infection. There was an infection control policy that outlined the collective responsibility of all staff and the doctor's responsibility. It explained their infection prevention and control programme and covered handwashing and protective clothing. Staff had received disinfection and contamination training in February 2013 and had a good knowledge of infection control management.

Checks were carried out on staff before they commenced employment. All staff had relevant qualifications and had received training in medical emergencies and CPR, disinfection and contamination and safeguarding.