We carried out this announced inspection on 4 April 2017 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 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

Smith & Luck is in Bushey, Hertfordshire and provides NHS and private treatment to patients of all ages.

There is ramp access to downstairs treatment rooms for people who use wheelchairs and pushchairs.

The dental team includes six dentists, five dental nurses, five dental hygienists, one administrative assistant and two receptionists. The practice has six treatment rooms.

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 Smith & Luck was the principal dentist.

On the day of inspection we collected 70 CQC comment cards filled in by patients. This information gave us a positive view of the practice.

During the inspection we spoke with 3 dentists, 3 dental nurses and 2 receptionists. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open: 9 am to 6 pm Monday to Friday.

Our key findings were:

• The practice was clean and well maintained.

• The practice had infection control procedures which reflected published guidance, but did not reflect the infection control policy which was found to be out of date

• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available, with the exception of an AED which was purchased following the inspection.

• The practice had systems to help them manage risk.

• The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.

• The practice had thorough staff recruitment procedures, although references and proof of identification were not always recorded.

• 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 although patient records stored in the reception area were not secured to prevent unauthorised access when reception was unmanned.

• The appointment system met patients’ needs.

• The practice had effective leadership. Staff felt involved and supported and worked well as a team.

• The practice asked staff and patients for feedback about the services they provided.

• The practice dealt with complaints positively and efficiently.

• The practice were taking some measures to limit the risk of Legionella growth, but did not arrange for a risk assessment to be completed until after the inspection.

During our previous inspection on the 9 November 2012, we found that the provider was not compliant with Regulation 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

We received an action plan from the provider telling us that they would be complaint with the regulation by 31 July 2013. On our follow –up inspection we found that the provider had made the required improvements and were now compliant with the regulation.

People that we spoke with told us that they felt comfortable to ask the dentist or other staff members questions about their treatment and the cost of their treatment and that the staff always had time to answer their queries and or questions. People confirmed that the dentist provided them with enough information to enable them to make an informed decision about the treatment they had required.

People felt that their dignity was maintained and their privacy protected as consultation and treatment were held in private rooms behind closed doors.