We carried out this announced inspection on 22 October 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

Harley Street provides 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 a lift that goes up to the treatment areas and staff stated patients in wheelchairs had accessed the treatment rooms using the lift.

The dental team includes eight dentist, five dental hygienist, one visiting seditionist, seven dental nurses, six receptionists, one concierge, one deputy practice manager and one practice manager. The practice has ten 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 at Harley St was the provider managers.

On the day of inspection, we collected six CQC comment cards filled in by patients.

During the inspection we spoke with a dentist, two dental nurses, a dental hygienist, a receptionist, the provider’s compliance manager and the practice manager. We also spoke to four patients. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

• Monday 8.00am to 6.00pm
• Tuesday8.00am to 8.00pm
• Wednesday8.00am to 6.00pm
• Thursday8.00am to 8.00pm
• Friday 8.00am to 6.00pm

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.
• 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 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 a 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. Although improvements could be made in regards to audits undertaken.
• The practice carried out conscious sedation for patients who would benefit. We found gaps in staff training and proper maintenance of records related to the procedures. These were brought to the attention of the provider and the provider made arrangements for appropriate training to be undertaken and records to be improved.

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

• Review the current staffing arrangements to ensure all dental care professionals are adequately supported by a trained member of the dental team when treating patients in a dental setting considering the guidance issued by the General Dental Council.

• Review the practice’s protocols for conscious sedation, taking into account guidelines published by The Intercollegiate Advisory Committee on Sedation in Dentistry in the document 'Standards for Conscious Sedation in the Provision of Dental Care 2015.

• Review the practice’s audit protocols to ensure audits of various aspects of the service, such as radiography and 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.