We carried out an announced comprehensive inspection on 21 March 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

Smile in London provides NHS and private dental treatment to patients of all ages in Leyton and the surrounding areas.

Practice staffing consists of four dentists, three dental nurses, one receptionists and a practice manager.

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 practice is open Monday to Friday 9am to 6pm and Saturdays 9am to 1pm

The practice facilities include four treatment rooms, reception and waiting area, decontamination room, X-ray room, office and a staff room/kitchen.

35 patients provided feedback about the service. Patients we spoke with and those who completed comment cards were very positive about the care they received about the service. Patients told us that they were happy with the treatment and advice they had received.

Our key findings were:

• There were systems in place to reduce the risk and spread of infection. Dental instruments were cleaned and sterilised in line with current guidance.
• There were systems in place to ensure that all equipment was maintained in line with manufacturer’s guidelines.
• Staff had received safeguarding children and adults training and knew the processes to follow to raise any concerns. The practice had whistleblowing policies and procedure and staff were aware of these and their responsibilities to report any concerns.
• The practice ensured staff were trained and that they maintained the necessary skills and competence to support the needs of patients.
• There were sufficient numbers of suitably qualified staff to meet the needs of patients.
• Staff had been trained to handle medical emergencies, and appropriate medicines and life-saving equipment were readily available.
• Patients received clear explanations about their proposed treatment, costs, benefits and risks and were involved in making decisions about it.
• Patients were treated with dignity and respect and confidentiality was maintained.
• The appointment system met the needs of patients and waiting times were kept to a minimum.
• The practice had a procedure for handling and responding to complaints, which were displayed and available to patients.
• Governance systems were effective and there were a range of policies and procedures in place which underpinned the management of the practice. Clinical and non-clinical audits were carried out to monitor the quality of services.
• The practice sought feedback from staff and patients about the services they provided and acted on this to improve its services.

One person we spoke to told us the dentist had explained to them the treatment they needed and was very clear about the fees they would have to pay for each treatment.

We saw that the practice had comprehensive records for each patient’s care. These included medical histories, an assessment of care, treatment plan, reviews of treatment and details of any changes to treatment plans.

Staff told us clinical guidance meetings were held every month and any incidents were discussed at these meetings. They said “if there was something we did wrong we discuss how it should be done and given guidance to try to ensure it does not happen again.”

There was an up to date safeguarding policy in place and it contained a clear procedure for staff to follow and details of agencies to contact if abuse was suspected. We saw that child and adult protection flow charts were displayed in all surgeries with information of who to contact if abuse was suspected.

The dental nurse told us it was their responsibility to ensure equipment is cleaned after use. They talked us through the process they used. We saw equipment used for treatment was sealed in plastic packs after they were sterilised.

We were told that all staff received an annual appraisal and we were shown copies of the last ones completed. These appraisals focused on performance for the past year and training needs for the coming year.