We carried out this announced inspection on 23 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

M J Pritchard Dental Surgery is in the London Borough of Kingston Upon Thames and provides NHS and private treatment to patients of all ages.

There is level access via a ramp for people who use wheelchairs and those with pushchairs.

The dental team includes two dentists, two dental nurses and a receptionist. The practice has two 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 received feedback from 41 patients.

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

The practice is open:

• Monday, Tuesday and Wednesday 9:00am to 5.00pm
• Thursday 9:00am to 6:30pm
• Friday 9:00am to 2:00pm
• Saturday 9:00am to 1:00pm

Our key findings were:

• The practice appeared clean and well maintained.
• The practice had infection control procedures that reflected published guidance.
• Staff knew how to deal with emergencies relating to basic life support training. 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.
• Staff felt involved, 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.
• The practice’s current system to provide dental care treatment under conscious sedation was not in line with current guidelines.

The shortcomings associated with providing dental care treatment under conscious sedation was discussed with the principal dentist during the inspection.

They provided us with a written assurance that treatment procedures under intravenous sedation would not be undertaken until other dental professionals at the practice had undertaken the required additional sedation and resuscitation training.

There were areas where the provider could make improvements, they should:

• Review the practice’s protocols for conscious sedation, taking into account the 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 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.

During our visit we spoke to two patients' who used the service and looked at feedback comments returned to the surgery. People told us "Fantastic here", "Always very good" and "Would recommend to all my friends and family".

Patients' said and we saw that staff treated them with dignity and respect.

They were given the information and time they needed to decide if the treatment recommended was what they wanted and this was the surgery they wished to provide it.

The procedure for consultation and treatment was fully explained including the cost of treatment.

Patients' were told about any risks that might arise from the treatment chosen and had received consultations and treatment in private.

They did not tell us about the surgery infection control system, complaints procedure or number of staff available to meet their treatment needs.

They did tell us and we saw that the surgery was kept clean, tidy and they felt safe using the service.

We found that the surgery gave suitable information so that people could make an informed decision if they wished to proceed with the proposed treatment.

We saw records were kept up to date and a suitable complaints procedure was in place that patients' had access to.

There were adequate numbers of suitably qualified staff to meet patients' needs.