We carried out an announced comprehensive inspection on 26 February 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

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

The practice staffing consists of three dentists, four dental nurses and one receptionist.

The practice is open from 9.00am to 8.00pm on Monday; 8.30am to 5.00pm on Tuesday; 9.00am to 7.30pm on Wednesday and 8.00am to 5.00pm on Thursday and Fridays. The practice is set out over three levels with one surgery on the ground floor and one on the first floor. There is no lift; however the surgery on the ground floor is wheelchair accessible. Other facilities include: two patient waiting rooms (one on each level); reception area; decontamination room and a staff office.

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 dentist specialist advisor.

We received feedback from 30 patients. Patient feedback was very positive about the service. Patients feedback included comments relating to staff being friendly and professional and providing an excellent service. They were also complimentary about the reception staff stating they were polite and courteous and provided excellent customer services. Information was given to patients appropriately and staff were helpful.

Our key findings were:

• Processes were in place for staff to learn from incidents and lessons learnt were discussed amongst staff.
• There were systems in place to reduce the risk and spread of infection. Dental instruments were decontaminated suitably.
• There were processes in place to protect patients from the risk of abuse.
• There was appropriate equipment for staff to undertake their duties, and equipment was maintained.
• The practice had access to an automated external defibrillator (AED) and the medical oxygen available on the premises was in date.
• The provider had emergency medicines in line with the British National Formulary (BNF) guidance for medical emergencies in dental practice.
• 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.

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

• Review the practice’s protocols for the use of rubber dam for root canal treatment giving due regard to guidelines issued by the British Endodontic Society
• Review processes are in place for the reqular maintenance and servicing of equipment including the X-ray equipment.

We inspected the dental practice to follow up on improvements we had asked them to make following a previous inspection on 14 February 2013. At the inspection on 26 July 2013 we found procedures were in place to deal with medical emergencies. The practice had taken action in line with national guidance on preventing the spread of infection and the provider was monitoring the quality of the service.

We spoke with two people using the service on the day of our inspection. They told us they were offered choices and felt consulted with about their needs and preferences. We saw from a review of treatment records that people were involved in decisions and gave consent for treatment, and that their medical history was checked. However the provider had not ensured expired items of equipment were removed from the surgeries where there was a risk they would be used to treat people, and the quality monitoring systems in place were not always effective. The provider had not followed their own infection control policy in the way instruments were cleaned.