We carried out this announced inspection on 15 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 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

Harrow Smile Clinic is in the London Borough of Harrow and provides NHS and private treatment to adults and children.

The dental team includes three principal dentists, six dentists, one hygienist, two dental nurses, two trainee dental nurses and a practice manager/receptionist.

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. The registered manager at Harrow Smile Clinic was one of the principal dentists.

On the day of inspection we collected 46 CQC comment cards filled in by patients.

During the inspection we spoke with the three principal dentists, one dentist, two dental nurses and the receptionist. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

• Monday to Thursday 8.30am to 5.30pm
• Friday 8.30am to 7.30pm
• Saturday 9am to 4pm

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.

We spoke with three people who use the service. Two people told us they were happy with the service overall, with one person saying "they really look after you here – have excellent service". Another person told us "I’m quite happy, they are very concerned with patients, the staff is good". The third person we spoke with told us the service was good, but they had trouble getting an appointment when they needed one. They told us "now it’s really difficult to get an appointment – I had a broken tooth and they told me I could only get an appointment in August" and "the dentists I have seen have all been very good".

We found that the provider conducted appropriate assessments of people's needs and planned their treatment in ways that protected their rights, but the service was operating at capacity and people reported they couldn't get an appointment when they needed to. We found that the provider had taken steps to safeguard people from the risk of abuse, and that most staff were qualified, skilled and experienced in their roles.

We found that the provider met the government standards for cleanliness and infection control, and had appropriate systems in place to assess the quality of the service provided.