We carried out this announced inspection on 1 April 2019 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 not providing well-led care in accordance with the relevant regulations.

Background

Perfect Teeth is in the London Borough of Enfield and provides NHS and private treatment to adults and children.

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

The dental team includes the principal dentist, two associate dentists, one hygienist, two dental nurses, one receptionist and a practice manager.

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 21 CQC comment cards filled in by patients.

During the inspection we spoke with the two associate dentists, two dental nurses, the receptionist 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 to Friday 9am to 5pm

Our key findings were:

• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• The provider 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.
• Staff were providing preventive care and supporting patients to ensure better oral health.
• The appointment system took account of patients’ needs.
• The practice dealt with complaints positively and efficiently.
• The practice’s infection control arrangements required improvement in areas.
• Risks arising from Legionella had not been suitably identified and mitigated.
• The practice had not carried out a Disability Access audit.
• The practice had not asked patients for feedback about the services they provided.
• The practice had ineffective systems to help them assess, monitor and manage risks relating to undertaking of the regulated activities at the time of this inspection, though they showed willingness to address the concerns we identified during the inspection.
• A fire risk assessment had not been completed.

We identified regulations the provider was not complying with. They must:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

Full details of the regulations the provider was not meeting are at the end of this report.

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

• Review its responsibilities to respond to meet the needs of patients with disability and the requirements of the Equality Act 2010.

Patients’ privacy was respected. Patients were able to discuss treatment, medical history, fees and other matters behind closed doors in a treatment room or in the practice manager’s office.

Patients we spoke with were positive about the quality of care and treatment received. One patient referred to the dentistry provided as “very good” whilst another remarked that they had “no problems at all” with their treatment.

Staff we spoke with demonstrated an understanding of safeguarding children and vulnerable adults. They could describe possible types of abuse and knew how to report a safeguarding concern.

The provider had systems in place to help ensure that patients were treated in a clean, hygienic environment and protected from the risk and spread of infection. None of the patients we spoke with expressed concern about cleanliness or the overall practice environment.

Staff records and other records relevant to the management of the service were accurate and fit for purpose. During the course of our inspection, the practice manager was able to promptly locate provider policies and procedures.

People who used the clinic told us they were treated with respect and dignity. They felt they had been provided with enough information regarding their treatment.

People felt that their needs were known to the staff. They said information about their needs had been obtained by the clinic so that appropriate treatment was provided to them. They felt the dentists were patient and provided them with information which they found helpful in making their own decisions.

People told us that the clinic appeared clean and they felt safe. They said they were satisfied with the cleanliness and hygiene of the place.