We carried out this announced inspection on 11 September 2018 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 this practice was providing safe care in accordance with the relevant regulations. We have told the provider to take action

Are services effective?

We found this practice was providing effective care in accordance with the relevant regulations.

Are services caring?

We found 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 this practice was providing well-led care in accordance with the relevant regulations. We have told the provider to take action

Background

Smile Centre is in Swindon, Wiltshire and provides private treatment to adults and children.

The dental team includes two dentists, a clinical dental technician, three dental nurses, a trainee dental nurse, a dental hygiene therapist, a receptionist, the practice manager and a business manager. The practice has two treatment rooms, a consultation room, a decontamination room and reception area.

The practice is owned by a partnership and as a condition of registration must have a person registered with the Care Quality Commission as the registered manager. Registered managers 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 registered manager at Smiles Centre is one of the partners.

On the day of inspection, we collected 17 CQC comment cards filled in by patients and spoke with two other patients.

During the inspection we spoke with one dentist, two dental nurses and the trainee dental nurse, one dental hygienist, the registered manager and the business manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

• Monday 9.30am – 6.00pm
• Tuesday 9.30am – 5.30pm
• Wednesday and Friday 9.30am – 5.00pm
• Thursday 9.30am – 8.30pm

• Closed at weekends.
• Out of Hours information is available via the telephone answering service.

Our key findings were:

• The provider had done a lot of work to address the issues of concern raised at our June 2018 inspection.
• The practice appeared clean and mostly well maintained. Attention is still required to ensure all clutter and hazardous wires are dealt with and the building works completed.
• The provider had infection control procedures which reflected published guidance.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• The practice had systems to help them manage risk to patients and staff. These systems were adequate in the main but certain areas of risk required more attention to detail for example the fire and health and safety actions identified following risk assessment.
• The practice staff had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
• The provider 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.
• The provider was providing preventive care and supporting patients to ensure better oral health.
• The appointment system met patients’ needs.
• The practice had effective leadership and a culture of continuous improvement.
• Staff felt involved, supported and worked well as a team.
• The practice asked staff and patients for feedback about the services they provided.
• The provider dealt with complaints positively and efficiently.
• The provider had suitable information governance arrangements.

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

• Review the practice risk management systems for monitoring and mitigating the various risks arising from the undertaking of the regulated activities. Review the fire safety and health and safety actions identified and ensure they are completed and ongoing fire safety management is effective.
• Review the practice policy for the control and storage of substances hazardous to health identified by the Control of Substances Hazardous to Health Regulations 2002, to ensure risk assessments are undertaken the products are stored securely and product information sheet are easily available to all staff.
• Review the practice policy for record keeping in relation to the management of the regulated activities reflecting attention to detail when making records as good practice and for accountability purposes.

We carried out this unannounced inspection on 04 June 2018 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 not providing safe care in accordance with the relevant regulations. We have told the provider to take action

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. We have told the provider to take action

Background

Smile Centre is in Swindon, Wiltshire and provides private treatment to adults and children.

The dental team includes two dentists, three dental nurses, a trainee dental nurse, a dental hygiene therapist, a receptionist and the practice manager. The practice has two treatment rooms, a consultation room, a decontamination room and reception area. The practice is open Monday, Tuesday, Wednesday and Friday 9:00am – 5:30pm and Thursday 9:00am – 8:00pm.

The practice is owned by a partnership and as a condition of registration must have a person registered with the Care Quality Commission as the registered manager. Registered managers 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 registered manager at Smile Centre was one of the partners.

During the inspection we spoke with a dentist, a dental nurse, a dental hygiene therapist, the practice manager, the registered manager and the director. We looked at practice policies and procedures and other records about how the service is managed.

Our key findings were:

• There was a lack of an effective system to assess, monitor and mitigate the risks relating to the health, safety and welfare of patients, staff and visitors.
• Governance arrangements were not effective to facilitate the smooth running of the service and there was no evidence of audits being used for continuous improvements.
• The practice did not have suitable processes for safeguarding adults and children.
• The practice did not have effective leadership.
• The practice did not have effective staff recruitment procedures.
• The practice did not have suitable information governance arrangements.
• The clinical staff provided patients’ care and treatment in line with current guidelines.
• Staff treated patients with dignity and respect.
• The practice was providing preventive care and supporting patients to ensure better oral health.
• The appointment system met patients’ needs.
• Staff felt involved and supported and worked well as a team.
• The practice staff dealt with complaints positively and efficiently.

We identified regulations the provider was not meeting. They must:

• Ensure care and treatment is provided in a safe way to patients.
• Ensure patients are protected from abuse and improper treatment.
• Ensure all premises and equipment used by the service provider is fit for use.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.
• Ensure specified information is available regarding each person employed.

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

• Review the practice’s arrangements for receiving and responding to patient safety alerts, recalls and rapid response reports issued from the Medicines and Healthcare products Regulatory Agency (MHRA) and through the Central Alerting System (CAS), as well as from other relevant bodies such as, Public Health England (PHE).

• Review the practice’s system for the recording, investigating and reviewing incidents or significant events with a view to preventing further occurrences and, ensuring that improvements are made as a result.

• Review the practice’s protocols for the use of closed circuit television cameras taking into account the guidelines published by the Information Commissioner's Office.

During our visit to Smiles Centre we met with the registered manager and spoke with three members of staff. We spoke with three patients and looked at two sets of patient records.

All of the patients we spoke with were very happy with the dental treatment they received. One said “It’s brilliant. They put me at ease and made me feel comfortable. He [the dentist] explained a lot about what was going on with my teeth. The hygienist has explained how to clean my teeth properly”. Another said “I wasn’t happy with my previous dentures. I came here and I explained what I wanted. They listened and told me it was possible. The cost of the work was fully explained”. Patients received a written treatment plan detailing treatment options and costs.

Patients we spoke with told us the practice was always clean and tidy. One said “it’s lovely and clean”. We found current infection control guidelines were followed to reduce the risk of infection.

Staff told us they were supported to carry out their roles. We saw staff received training specific to their job and received regular supervision and appraisal.

The practice had systems in place to seek regular feedback from patients to enable them to improve the service it offered. The practice had carried out audits to monitor clinical quality and improve the service.