We carried out this announced inspection on 19 October 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 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

Tangmere Gardens Smile Centre is in the London Borough of Ealing and provides NHS and private treatment to adults and children.

There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces are available near the practice.

The dental team includes a principal dentist, a compliance manager, practice manager, practice supervisor, six dentists, two hygienists, a visiting dentist with a special interest in dental implant surgery, a foundation training therapist, five dental nurses, two trainee dental nurses and one receptionist.

The practice is owned by an organisation 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 Tangmere Gardrens Smile Centre was the practice manager

On the day of inspection, we collected 29 CQC comment cards filled in by patients.

During the inspection we spoke with the principal dentist, one dentist, one hygienist, the compliance manager, practice supervisor, practice manager, two dental nurses and the receptionist. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

• Monday, Tuesday 9am to 8pmpm
• Wednesday, Thursday and Friday 9am to 6pm

Our key findings were:

• The practice appeared clean and well maintained.
• The practice 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.
• The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• The practice 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 practice 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 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 had suitable information governance arrangements.

We spoke with four people who use the service who had been visiting the surgery for a number of years and said their immediate family were also registered with the surgery. People said they were given a good explanation of the treatment required, staff were friendly and approachable, and they felt the practice accommodated their children well. Some of the comments made were "they are very good and helpful” and "we are all satisfied with the service". Information was available at the surgery to support people to make decisions about their treatment. People had a treatment plan which reflected their assessed dental treatment needs.

On the day of the inspection we found the surgery to be clean and saw that a decontamination process was in place for dental instruments. Information was available for staff on safeguarding children and vulnerable adults and how to escalate a concern if necessary.

There was a schedule of training and practice meetings for staff development. A management system was in place to ensure the service was safe, and care and treatment was regularly evaluated. The manager had identified that the service to people needed to be provided in a better environment. As a result of this, plans had been submitted to the local authority for the extension and modernisation of the surgery.