We carried out this unannounced inspection on 5 September 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

Mottingham Dental Practice is in the Royal Borough of Greenwich and provides

NHS and private treatment to adults and children.

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

Car parking spaces are available near the practice.

The dental team includes four dentists, a dentist with a special interest in implant surgery, a periodontist, four dental nurses, a practice manager, a receptionist and a cleaner.

The practice has three treatment rooms.

The practice is owned by a company 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 Mottingham Dental Practice is the principal dentist.

On the day of inspection we spoke with three patients.

During the inspection we spoke with the principal dentist, a 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:

Our key findings were:

• The practice appeared clean and well maintained.
• The provider 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 to patients and staff.
• The practice staff had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
• The provider 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 provider was providing preventive care and supporting patients to ensure better oral health.
• The appointment system met patients’ needs.
• The practice had effective leadership and 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 provider dealt with complaints positively and efficiently.
• The provider had suitable information governance arrangements.

There were areas where the provider could make improvements. They should:

Review the practice’s audit protocols to ensure infection control audits are undertaken at regular intervals and where applicable learning points are documented and shared with all relevant staff.

We carried out a follow up inspection at Mottingham Dental Practice on 7 December 2016.

We had undertaken an announced comprehensive inspection of this service on 5 May 2016 as part of our regulatory functions where a breach of legal requirements was found. This report only covers our findings in relation to those requirements and we reviewed the practice against two of the five questions we ask about services: is the service safe and well-led?

We revisited Mottingham Dental Practice as part of this review and checked whether they had followed their action plan and to confirm that they now met the legal requirements.

We found that this practice was now providing safe and well-led care in accordance with the relevant regulations.

We carried out an unannounced comprehensive inspection on 5 May 2016 to ask the practice the following key questions; Are services safe, effective, caring, responsive and well-led?

Our findings were:

Are services safe?

We found that this practice was not 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 not providing well-led care in accordance with the relevant regulations

Background

Mottingham Dental Practice is located in the London Borough of Greenwich and provides predominantly NHS dental services. The demographics of the practice were generally mixed, serving patients from a range of social and ethnic backgrounds.

The practice staffing consists of three dentists, three dental nurses, a trainee dental nurse and two receptionists.

The practice is open from 9.00am to 7.00pm on Monday to Thursdays; 9.00 to 5.00pm on Fridays and 9.00am to 1.00pm on Saturdays. The practice is set out on one level (ground floor) and all patient areas are step free. The facilities include three consultation rooms, a reception area, patient waiting room and a room used as a staff kitchen and decontamination. The premises were wheelchair accessible although the toilet was not wheelchair.

The principal dentist is the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons 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 inspection took place over one day and was carried out by a CQC inspector and a dental specialist advisor.

We received feedback from three patients through completed Care Quality Commission comment cards. Patient feedback was very positive about the service. They were also complimentary about the staff stating they were polite and courteous.

Our key findings were:

• Systems were in place for the provider to receive safety alerts from external organisations and they were shared appropriately with staff.
• Processes were in place for staff to learn from incidents and lessons learnt were discussed amongst staff.
• The practice had access to an automated external defibrillator (AED) and medical oxygen.
• There were processes in place to safeguard patients.
• Patients’ needs were assessed and care was planned in line with current guidance.
• Patients were involved in their care and treatment planning so they could make informed decisions.
• All clinical staff were up to date with their continuing professional development.
• There was appropriate equipment for staff to undertake their duties, and equipment was well maintained. However portable appliance testing was overdue.
• There were systems in place for patients to make a complaint about the service if required.
• There was lack of effective systems in place to reduce the risk and spread of infection. Dental instruments were not always decontaminated suitably.
• The practice was not carrying out risk assessments regularly to ensure the health and safety of people who used the service.
• There were inadequate governance arrangements in place to ensure that quality and performance were regularly monitored.

We identified regulations that were not being met and the provider must:

• Ensure the practice’s infection control procedures and protocols are suitable giving due regard to guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices and The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance’.
• Ensure the practice’s sharps handling procedures and protocols are in compliance with the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.
• Ensure systems are in place to assess, monitor and improve the quality of the service such as undertaking regular audits of various aspects of the service and ensuring that where appropriate audits have documented learning points and the resulting improvements can be demonstrated.
• Ensure an effective system is established to assess, monitor and mitigate the various risks arising from undertaking of the regulated activities.

You can see full details of the regulations not being met at the end of this report.

People using the service we spoke with were very happy with the service. They told us that they trusted their dentist, and felt comfortable and safe with them. For example, one person said: “They’re all right here. I’ve always liked it here. I tried another dentist near where I live who wasn’t any good.” Another person said: “[My dentist] is lovely. She’s fantastic. I’ve got faith in her and [the dental nurse]. They gave me the paper, all about blood clots and such, but I’m fine with them.”

We looked at 16 of the 51 completed patient questionnaires the practice had collected. All but one of these rated all aspects of the practice, including staff friendliness, cleanliness and waiting time, as excellent or good. The questionnaires also showed the respondents: felt the cost of their treatment had been fully explained to them; confirmed the dentist had answered all their questions about their treatment; and felt confident about the quality of treatment the dentists were providing.

We found people using the service were involved in decisions about their care and were treated with dignity and respect. They experienced treatment and care that met their needs and were protected from the risk of infection. Safeguards were in place to protect people from abuse and the provider had a system in place for monitoring the quality of service people received.