We carried out an announced comprehensive inspection on 15 January 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 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

Saini Dental Practice is located in the London Borough of Brent and provides private and NHS dental services. The staff structure of the practice consists of a principal dentist, a practice manager, and a trainee nurse. The practice premises consists of a treatment room, a decontamination room and a waiting room.

The provider is registered with the Care Quality Commission (CQC) as an individual. 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 was unannounced as concerns about the practice were brought to our attention. The inspection took place over one day and was carried out by two CQC inspectors and a dental specialist advisor.

Our key findings were:

• The practice had suitable processes around reporting and discussion of incidents.
• Staff were trained and there was appropriate equipment to respond to medical emergencies. An automated external defibrillator (AED), was however not available in line with current guidance and there had been no risk assessment completed to assess the risks of not having this equipment.
• Patients told us that staff were caring and treated them with dignity and respect.
• There was appropriate equipment for staff to undertake their duties and equipment was well maintained.
• There were effective systems in place to reduce and minimise the risk and spread of infection, though some improvements were needed.
• There were processes in place for patients to give their comments and feedback about the service including making complaints and compliments.
• Patients indicated that they felt they were listened to and that they received good care from a helpful and caring practice team.
• The practice had effective safeguarding processes in place, though improvements could be made in some staff’s understanding of safeguarding of patients.
• Improvement could be made to ensure the practice give due regard to current guidelines such as from the National Institute for Health and Care Excellence (NICE).
• Governance arrangements were in place for the smooth running of the practice.

There were areas where the provider could make improvements and should:

• Review staff training to ensure that all of the staff had undergone relevant training, to an appropriate level, in the safeguarding of children and vulnerable adults.
• Review the availability of equipment to manage medical emergencies giving due regard to guidelines issued by the British National Formulary, the Resuscitation Council (UK), and the General Dental Council (GDC) standards for the dental team.
• Review recruitment procedures to ensure accurate, complete and detailed records are maintained for all staff.
• Review the practice’s infection control procedures and protocols 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.’
• Review the practice's policy and the storage of products identified under Control of Substances Hazardous to Health (COSHH) 2002, Regulations.
• Review the protocols and procedures for use of X-ray equipment giving due regard to Guidance Notes for Dental Practitioners on the Safe Use of X-ray Equipment.
• Review the practice protocols and adopt an individual risk based approach to clinical decisions such as patient recalls and wisdom teeth removal giving due regard to National Institute for Health and Care Excellence (NICE) guidelines.
• Review the practice protocols to ensure the training, learning and development needs of individual staff members are reviewed at appropriate intervals and an effective process is established for the on-going assessment and supervision of all staff.

We spoke with five people who use the service. Each person we spoke with had been registered with the practice for decades; all spoke positively of the provider and the service's role in the community. One person said "I'm extremely happy, the dentist always explains what he is doing. He’s very knowledgeable". Another person told us the dentist "is always very kind and understanding". Another person told us "he looks after me. He’s been excellent, I am very satisfied with everything".

People who use the service told us they were satisfied with the cleanliness of the practice. This was reflected in the results of patient satisfaction surveys. We found the provider followed the guidelines for the decontamination of dental instruments.

We found the service protected people from the risks of abuse, and followed safer recruiting practices. Staff were skilled, experienced and qualified to perform their roles.

The provider had good management practices, and conducted regular audits and sought feedback from people who use the service.