We carried out this announced inspection on 17 May 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.

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

Malo Clinic at Elmfield House Dental Practice is in, Teddington, London Borough of Richmond Upon Thames and provides private treatment to patients of all ages.

There is access for people who use wheelchairs and those with pushchairs. Car parking spaces, including one for patients with disabled badges, are available near the practice.

The dental team includes eight dentists, five dental nurses, two dental hygienists, two dental technicians and one practice manager. The practice has four treatment rooms.

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 was the principal dentist.

On the day of inspection we collected 18 CQC comment cards filled in by patients. This information gave us a positive view of the practice.

During the inspection we spoke with two dentists, three 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:

• Monday, Tuesday and Friday: 9:30am to 5:00pm

• Wednesday and Thursday: 9:00am to 7:00pm

Our key findings were:

• The practice was 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.
• The practice had systems to help them manage risk.
• 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 appointment system met patients’ needs.
• 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.

There were areas where the provider could make improvements, they should:

• Review availability of equipment to manage medical emergencies taking into account guidelines issued by the Resuscitation Council (UK), and the General Dental Council (GDC) standards for the dental team.
• Review the practice's protocols for medicines management and ensure all medicines are stored and dispensed safely and securely.

People who used the service understood the care and treatment choices available to them. We looked at the patient handbook which informed patients of what to expect. Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. During our visit we looked at the consent policy used by the practice.

We spoke with twelve patients. The people we spoke with confirmed that they had completed a medical history form and this was updated at each appointment. One person said "The dentist makes a point of asking about my health each time". Someone else told us "I have a full dental check-up and assessment at every appointment".

We saw that staff had received infection control and prevention updates and we found certificates from training attended by clinical staff. There was an infection control policy and procedures used by the practice.

Staff received appropriate professional development. We looked at the training records of several staff working at the practice. Staff had completed a range of training including first aid and life support training.

During our inspection we saw a copy of the complaints and whistleblowing policy. Information was made available to people about what to do if they were unhappy with their dental care. We spoke with twelve people who commented on their level of satisfaction. Feedback provided by these patients was supportive, and included comments like "A very good service".