We carried out this announced inspection on 19 April 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 did not provide any 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

London Road Dental Centre is in Croydon and provides NHS and private treatment to patients of all ages.

There is level access for people who use wheelchairs and pushchairs.

The dental team includes five dentists, four trainee dental nurses and four receptionists. The practice has three treatment rooms, two decontamination rooms, two patient waiting rooms and staff 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 31 CQC comment cards filled in by patients. This information gave us a positive view of the practice.

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

The practice is open: 9.30am to 6.00pm Monday to Fridays and 9.30am to 1.00pm on Saturdays.

Our key findings were:

• The practice appeared clean and was 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 safeguarding processes in place however the safeguarding policy required updating. Staff knew their responsibilities for safeguarding adults and children.
• The practice had staff recruitment procedures however they were not always following them when recruiting staff.
• 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.

We carried out this visit to determine if the provider had taken action to address the areas where we found non-compliance during our last inspection in February 2014.

At our inspection of April 2014 we found the provider had taken action which included improving the way they recorded details of oral health assessments. They had introduced a number of clinical audits, and had taken action where the outcomes were not as good as they felt they needed to be.

The number of satisfaction surveys carried out of people using the service had been increased, and people were encouraged to give feedback after each visit.

We spoke with six patients who all gave positive feedback about the care and treatment they had received. One patient told us "I always had a big fear of dentists for years before I saw Smita (the dentist). She has really helped me.”

Patients told us that they were involved in treatment decisions, costs were explained and they were given time to think before undergoing treatment.

We had concerns that the provider did not adequately record a risk assessment process for oral disease and therefore was unable to monitor changes in a person's oral health effectively.

We observed staff speaking to patients politely both at the practice and over the telephone and found they were happy to answer questions. We observed that records relating to patients were kept securely ensuring confidentiality.

The prevention and control of infection and decontamination of instruments was effectively carried out in accordance with guidance from the Department of Health. Patients we spoke with were generally positive about the cleanliness of the practice telling us “Everything seems clean and tidy.”

We found that staff were well supported in their professional development and encouraged to take part in additional training. The provider did not have an effective system in place to regularly assess and monitor the quality of service that people receive. We found limited evidence that learning from incidents took place and that where changes were needed how these had been implemented.