We carried out this announced inspection on 27 July 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

Lorna Doone dental practice is in Surrey and provides private treatment to patients of all ages and NHS treatment to children..

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

The dental team includes 4 dentists, 1 hygienist, 2 dental nurse, 2 trainee dental nurses, 1 receptionists and a practice manager. The practice has three treatment rooms, one on an upper floor via a staircase and two at ground level.

The practice is owned by the partnership of Dr Nicholas and Dr Josephine Jullien 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 Lorna Doone dental practice is Dr Josephine Jullien one of the principal dentists.

On the day of inspection we collected 50 CQC comment cards filled in by patients. This information gave us a positive view of the practice.

During the inspection we spoke with the both principal dentist, one hygienist, one dental nurse 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 8.30-17.30

Tuesday 08.30-13.00

Wednesday 08.30-17.30

Thursday 08.30-17.30

Friday 08.30 13.00. However we were advised on Friday that the practice can be flexible for patients and may stay open later. The surgery is closed over the weekend...

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 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 policies to ensure all documents are providing the latest requirements and guidance.
• Review its responsibilities to the needs of people with a disability, including those with hearing difficulties and the requirements of the Equality Act 2010.
• Review availability of an interpreter services for patients who do not speak English as a first language.
• Review the practice's protocols for completion of dental care records taking into account guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.
• Review the practice’s systems in place for environmental cleaning taking into account current national guidelines.
• Review the security of NHS prescription pads in the practice and ensure there are systems in place to monitor and track their use.

At our last inspection in March 2013, we found the practice was not meeting the requirements of regulation concerned with cross infection. This was due to the infrequency of auditing of cross infection procedures at the practice. Since then, the practice had increased the frequency of infection control audits to meet best practice requirements. We were shown infection control audits for April and June 2013 and February 2014. The most recent audit demonstrated the practice was 96% compliant with best practice guidance and standards. There were plans in place to become 100% compliant by April 2015.

At this inspection we found the practice had robust infection control procedures in place. There was an up to date policy and procedure in place and staff were knowledgeable about its content. The staff had received refresher training in infection control in September 2013 to further enhance their knowledge and skills.

Since the last inspection the practice had developed a plan to meet best practice requirements. We were shown the ground plans for a new decontamination room, equipped with washer/disinfector. We were told by the provider, the new decontamination room would be completed before April 2015.

This meant that patients were protected from the risk of cross infection because appropriate guidance was followed.

We spoke with three patients after they had received treatment on the day of our visit. All of these patients were happy overall with the treatment they had received over the time they had been attending the practice. Where appropriate they had been given treatment options and the information they needed to be able to make their choice. They felt that their decisions and opinions were respected by the staff. One remarked that, “It was a brilliant practice" and two patients commented on how caring the dentists and their staff were.

We found that patients were given appropriate information about their treatment. Information was collected and updated about patient's medical conditions to ensure patients remained safe when being treated. Equipment was available and staff trained to deal with medical and other foreseeable emergencies.

There were systems in place to reduce the risk and spread of infection however we were not assured of the effectiveness of these are the required audits were considerably overdue. There was a commitment by all staff to remaining appropriately trained. Patient records were compiled and maintained adequately and stored securely.