We carried out an announced comprehensive inspection on 8 September 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

The Thames Street Dental Surgery is located in the London Borough of Kingston-upon-Thames. The premises are situated in a high-street location. There is one treatment room, a decontamination room, a reception room, a waiting room, a patient toilet, and a staff kitchen. These are distributed across the first and second floors of the building.

The practice provides NHS and private services to adults and children. The practice offers a range of dental services including routine examinations and treatment, veneers and crowns and bridges.

The staff structure of the practice consists of a principal dentist, a dental nurse and a receptionist.

The practice opening hours are from 9.00am to 1.00pm on Monday, Wednesday and Friday, and from 9.00am to 6.00pm on Tuesdays and Thursdays.

The principal dentist is registered with the Care Quality Commission (CQC) as an individual registered person. 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 dental specialist advisor.

Eighteen people provided feedback about the service. Patients were positive about the care they received from the practice. They were complimentary about the friendly and caring attitude of the dental staff.

Our key findings were:

• Patients’ needs were assessed and care was planned in line with current guidance such as from the National Institute for Health and Care Excellence (NICE).

• There were effective systems in place to reduce and minimise the risk and spread of infection.

• The practice had effective safeguarding processes in place and staff understood their responsibilities for safeguarding adults and children living in vulnerable circumstances.

• There were effective arrangements in place for managing medical emergencies.

• Equipment, such as the autoclave (steriliser), fire extinguishers, and X-ray equipment had all been checked for effectiveness and had been regularly serviced. The air compressor was booked for a service in the week following the inspection.

• Patients indicated that they felt they were listened to and that they received good care from a helpful and caring practice team.

• The practice ensured staff maintained the necessary skills and competence to support the needs of patients.

• The practice had implemented clear procedures for managing comments, concerns or complaints.

• The provider had a clear vision for the practice and staff told us they were well supported by the management team.

• There were some governance arrangements in place and infection control audits were effective in improving the quality and safety of the services. However, further improvements could be made to governance arrangements through the use of a wider range of policies, structured audits and risk assessments.

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

• 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 rubber dam for root canal treatment taking into account guidelines issued by the British Endodontic Society.
• Review the practice’s safeguarding training; ensuring it covers both children and adults and all staff are trained to an appropriate level for their role and aware of their responsibilities.
• Review the practice’s sharps procedures giving due regard to the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.
• Review the practice’s protocols for recording in the patients’ dental care records or elsewhere the reason for taking the X-ray and quality of the X-ray giving due regard to the Ionising Radiation (Medical Exposure) Regulations (IRMER) 2000.
• Review the practice’s use of audit protocols for various aspects of the service, such as radiography and dental care records, to help improve the quality of service. The practice should check that where applicable audits have documented learning points and the resulting improvements can be demonstrated.
• Review the practice’s use of risk assessment processes, for example, in relation to fire or general health and safety, with a view to identifying and further reducing the risks to patients and staff.

People using the service told us that they were happy with the way it was provided. They said "The dental practice is clean and reasonably priced", "I am dealt with promptly and professionally". The consultation and treatment process was fully explained including the cost. People were also told about any risks that may arise regarding treatments chosen. They felt treated with dignity, respect and had received consultation and treatment in private. They did not tell us about the infection control systems, number of staff employed or the complaints system. They did tell us they thought the practice was kept very clean, tidy and they felt safe using it. They thought staff were professional, polite and friendly. They were aware of how to complain but said they had never had cause to do so.