We carried out an announced comprehensive inspection on 23 August 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 Dental Practice is located in the London Borough of Southwark and provides NHS and private dental treatment to both adults and children. The premises are on the ground floor and consist of three treatment rooms, an X-ray room, a reception area and a dedicated decontamination room. The practice is open Monday to Thursday 9:00am – 6:00pm and Friday 9:00am – 5:00pm.

The staff consists of the principal dentist, two associate dentists and three dental nurses who are also receptionist.

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.

We reviewed 23 CQC comment cards and the NHS Friends and Family test. Patients were positive about the service. They were complimentary about the friendly and caring attitude of the staff.

The inspection took place over one day and was carried out by a CQC inspector and a dental specialist advisor.

Our key findings were:

• We found the dentists regularly assessed each patient’s gum health and took X-rays at appropriate intervals.
• Patients were involved in their care and treatment planning so they could make informed decisions.
• There were effective processes in place to reduce and minimise the risk and spread of infection.

• Equipment, such as the autoclave (steriliser), fire extinguishers, and X-ray equipment had all been checked for effectiveness and had been regularly serviced.

• Patients were treated with dignity and respect and confidentiality was maintained.
• The practice had implemented clear procedures for managing comments, concerns or complaints.
• Patients indicated that they found the team to be efficient, professional, caring and reassuring.
• Patients had good access to appointments, including emergency appointments, which were available on the same day.
• Leadership structures were clear and there were processes in place for dissemination of information and feedback to staff.
• 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 appropriate equipment and access to emergency drugs to enable the practice to respond to medical emergencies. Staff knew where equipment was stored.

There were areas where the provider could make improvements and should

• Review the storage of records related to people employed and the management of regulated activities giving due regard to current legislation and guidance.
• 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 storage of dental care records to ensure they are stored securely.
• Review the practice’s safeguarding policy and staff training ensuring it covers both children and adults and all staff is trained to an appropriate level for their role and aware of their responsibilities.
• Review its responsibilities as regards to the Control of Substance Hazardous to Health (COSHH) Regulations 2002 and, ensure all documentation is up to date and staffs understand how to minimise risks associated with the use of and handling of these substances.
• Review the practice’s protocols for the use of rubber dam for root canal treatment giving due regard to guidelines issued by the British Endodontic Society.

At our inspection of 23 July 2013 we found there were shortfalls in the service’s arrangements for assessing and planning people's care and treatment as some patients’ treatment plans were incomplete and not fully up to date. We also found shortcomings in the arrangements for the decontamination of dental instruments where national guidelines were not being followed, which could place people at risk of infection. Consequently the provider was not meeting the standards for regulations 9 and 12. We also received anonymously information of concern about the service’s arrangements in these areas.

At our inspection of 28 January 2014, we did not speak to people who used the service as the focus of our inspection was the practice’s completion of treatment plans and infection prevention and control processes. We found that the provider had made improvements in response to the previous inspection and was now meeting the essential standards of quality and safety under regulations 9 and 12. The shortcomings in treatment plans had mostly been addressed and appropriate guidance was now being followed to protect people from the risk of infection.

We spoke to three people who used the service. Two of them were happy with the service received. The other person felt that the initial consultation could have been more clearly explained but was otherwise satisfied.

People felt staff were welcoming and friendly and treated them with respect. One person said, "The staff are always polite and helpful." Another person said, "I have a phobia about dental treatment but I felt reassured by the way the dentist dealt with this at my first appointment."

There were arrangements for assessing and planning people’s care and treatment. However, some treatment plans were incomplete and not fully up to date.

There were suitable emergency arrangements in place in order to ensure patient safety.

There were arrangements in place for the decontamination of dental instruments. However, there some shortfalls in these arrangements where national guidelines were not being followed, which could place people at risk.

There were appropriate arrangements in place for supporting staff.

People’s records were appropriately managed and securely stored.