We carried out this announced inspection on 4 October 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.

We told the NHS England area team and Healthwatch that we were inspecting the practice. They provided information which we took into account.

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

Let's Smile Limited also known as Stanstead Abbotts Dental Care is in Stanstead Abbotts, and provides NHS and private treatment to patients of all ages.

There is a portable ramp for access for people who use wheelchairs or pushchairs. Car parking spaces are available on the street and in a public car park near the practice.

The dental team includes three dentists, four dental nurses/receptionists, one dental hygienist and two practice managers. The practice is situated on the ground floor and has three 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 collected 44 CQC comment cards filled in by patients and spoke with two other patients. This information gave us a positive view of the practice.

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

The practice is open: Monday, Tuesday and Thursday from 8am to 1pm and from 2pm to 6pm. Wednesday from 8am to 1pm and from 2pm to 7pm and Friday from 8am to 1pm and from 2pm to 5pm. The practice offers occasional Saturday morning services from 8am to 12am by appointment.

Our key findings were:

• The practice was visibly clean. There were no cleaning schedules in place and no review of housekeeping and maintenance tasks.
• The practice had infection control procedures; improvements were required to ensure staff followed the processes and published guidance.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• The practice did not have formalised 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 the practice’s system for recording, investigating and reviewing incidents or significant events with a view to preventing further occurrences and ensuring that improvements are made as a result.
• Review the practice’s infection control procedures and protocols to take into account guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices and have regard to The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance’
• Review the practices’ current Legionella risk assessment and implement the required actions taking into account guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices and have regard to The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance,’ including the regular monitoring of water temperatures.
• Review practice's recruitment procedures to ensure that appropriate background checks are completed prior to new staff commencing employment at the practice. .
• Review the practice’s protocols for domiciliary visits taking into account the 2009 guidelines published by British Society for Disability and Oral Health in the document “Guidelines for the Delivery of a Domiciliary Oral Healthcare Service”.
• Review the staff supervision protocols and ensure an effective process is established for the on-going appraisal of all staff.

When we inspected Let's Smile Limited on 04 October 2013 we saw that people were given information about their treatment and its cost and they were asked for their consent. One person who was visiting the practice on the day of our inspection told us, “I asked for, and was given, information about different costs for private and NHS treatment so I could decide what I wanted.” We also saw that people had signed the relevant NHS forms indicating their agreement to treatment.

People's dental needs were assessed and treatment planned in accordance with those needs. We also noted that people had the opportunity to discuss their long-term dental health. One person told us, “This was the first time I have met this particular dentist. They took photos and x-rays and we looked at them together and discussed future treatments that I might need later.”

The dental staff were trained in basic life support and the appropriate emergency equipment and medicine was checked weekly to ensure they were still within their expiry dates.

Used dental instruments were subjected to a decontamination process that met the Department of Health's guidance on decontamination. One person visiting the practice on the day of our inspection told us, “They are very clean. They all wear tunics, aprons, masks, gloves and glasses. I also have to wear glasses.”

Staff members were supported through effective supervision. Staff also maintained their General Dental Council registration by means of continuing professional development.

The provider carried out a range of audits to ensure that the practice operated safely. The provider was in the process of auditing the practice's policies and training files. This was part of an on-going work programme that had begun when they acquired the practice earlier in the year.