We carried out this announced inspection on 16 August 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.

We told the NHS England area team we were inspecting the practice. They provided information which we took into account.

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

The Dental Surgery Denmark Hill is in Denmark Hill and provides NHS and private treatment to patients of all ages.

There is access for people who use wheelchairs and those with pushchairs.

Car parking spaces are available near the practice.

The dental team includes a dentist and a dental nurse.

The practice is owned by an individual who is the principal dentist there. They have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run.

On the day of inspection we collected 48 CQC comment cards filled in by patients. This information gave us a positive view of the practice.

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

The practice is open Monday to Thursday 8.45am to 5.00pm.

Our key findings were:

• The practice was generally clean and well maintained.
• The practice had infection control procedures which reflected published guidance, but some improvements were required.
• Staff knew how to deal with emergencies and appropriate medicines and life-saving equipment were available, although there were some improvements required to the range of equipment that was 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 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 provider was made aware of our findings, especially as regards the lack of suitable risk assessment to undertake dental procedures safely under conscious sedation.

The provider responded appropriately within the required time frame to inform us of the urgent actions

they had undertaken to mitigate the risks. These included voluntary cessation of the provision of dental care services under conscious sedation with immediate effect.

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

• Review the practice’s safeguarding policy 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 stocks of medicines, materials and equipment and the system for identifying and deposing of out-of-date stock.

• Review the security of prescription pads in the practice and ensure there are systems in place to monitor and track their use.

• 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 ensuring compliance with the Ionising Radiation (Medical Exposure) Regulations (IRMER) 2000.

• Review the practice's protocols for conscious sedation, giving due regard to 2015 guidelines published by The Intercollegiate Advisory Committee on Sedation in Dentistry in the document 'Standards for Conscious Sedation in the Provision of Dental Care 2015.

• Review the protocols and procedures for use of X-ray equipment taking into account Guidance Notes for Dental Practitioners on the Safe Use of X-ray Equipment.
• Review the use of amalgamator mixer machine and consider safer alternatives.

The Dental Surgery, Denmark Hill (locally known as the Philip Norton Dental Practice) is a clean and professionally managed dental practice. The registered provider made considerable effort to ensure that patients were comfortable, safe and treated with the best possible care. People who use the service were very positive in their comments about the practice, and told us that all treatment options and associated costs were fully explained during their visits. There were suitable safeguarding and emergency arrangements in place in order to ensure patient safety.