We carried out an announced comprehensive inspection on 7 September 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

Salcot Crescent Dental Practice is a mixed NHS dental practice in Croydon. The practice is situated in a converted residential property. The practice has five dental treatment rooms, two patient waiting rooms and a separate decontamination room for cleaning, sterilising and packing dental instruments. In addition there is a reception and waiting area for patients.

The practice is open 8.45am to 5.00pm Monday to Fridays. The practice has five dentists and they are supported by six dental nurses. Other staff included a dental hygienist, a practice manager and two receptionists.

The principal dentist 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.

Before the inspection we sent Care Quality Commission comment cards to the practice for patients to complete to tell us about their experience of the practice. We received feedback from 32 patients via completed comment cards and speaking with patients on the day of the inspection. Patients provided a positive view of the services the practice provides. Patients commented on the quality of care, the friendliness and professionalism of all staff, the cleanliness of the practice and the overall quality of customer care.

Our key findings were:

• We found that the practice ethos was to provide patient centred dental care in a relaxed and friendly environment.
• Staff had been trained to handle emergencies and appropriate medicines and life-saving equipment was readily available in accordance with current guidelines.
• The practice appeared clean and well maintained.
• Infection control procedures were robust and audits were being completed every 6 months.
• The practice had a safeguarding lead with information available to staff to refer to. Staff demonstrated knowledge of safeguarding.
• The practice had a system in place for reporting incidents which the practice used for shared learning.
• Dentists provided dental care in accordance with current professional and National Institute for Care Excellence (NICE) guidelines.
• The service was aware of the needs of the local population and took these into account in how the practice was run.
• Patients could access treatment and urgent and emergency care when required.
• Staff recruitment files were organised and included relevant pre recruitment documents such as interview notes, CVs and references.
• There was a structured approach to learning and development and core training was provided by the owner. Staff had the opportunity to attend learning and training events.
• Staff we spoke with felt well supported by the practice owner and were committed to providing a quality service to their patients.
• Feedback from patients gave us a positive picture of a friendly, caring, professional and high quality service.

There was one area where the provider could make improvements and should:

Review the storage of dental care records to ensure they are stored  securely.

We found that people were cared for in a clean, hygienic environment and were protected from the risk of infection because appropriate guidance had been followed. Regular infection control audits were conducted. The surgery had a dedicated decontamination room which was clean and well organised with sufficient work space to allow for clean and dirty instruments to be kept separately. Staff we spoke with were familiar with and applied the government standards for decontamination, sterilisation and storage of re-usable clinical equipment in dental practices.

During this inspection we found staff received appropriate training, supervision and professional development. Staff we spoke with told us they felt they were working in a supportive environment where they were enabled to raise any issues affecting their roles. A staff member told us, "It's good we get together regularly now, you really feel like part of a team."

We found that people understood the care and treatment choices available to them and were involved in their treatment planning. One person told us, "I was involved in putting my treatment plan together. We discussed everything and I know exactly what is going on."

People's needs were assessed and treatment planned before treatment began. People we spoke with were very satisfied with the quality of their care and treatment. Comments we received included, "They are brilliant. They answer the phones promptly and always try to find an appointment that fits in with my working hours." "The staff are very friendly and professional." "I like the way that every move is explained."

However, we were concerned that there were not always effective systems in place to reduce the risk and spread of infection. Staff did not wear aprons whilst cleaning used instruments and then went on to assist dentists with the treatment of patients. We found there was not a clear separation between the clean and dirty area during the process of sterilising instruments and there was uncertainty among staff as to the use by date of instruments which had been sterilised.

We were concerned that although staff received appropriate training, they were not adequately supported by the service because they did not have staff or supervision meetings, or appraisals.

We found the provider had an effective system to regularly assess and monitor the quality of service that people receive.