We carried out an announced comprehensive inspection on 16 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

Tolworth Rise Practice is located in the Royal Borough of Kingston and provides private dental services. The opening hours for the practice were 8.45 am to 5.15 pm Monday to Friday.

The premises consists of two treatment rooms, a decontamination room and a waiting area.

The practice comprises of two dentists, a dental nurse, and one receptionist/nurse.

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.

During the inspection we asked patients to complete CQC comment cards. We received 16 comment cards back from patients and spoke with three patients on the day of the inspection. The patients who provided feedback were positive about the care and treatment they received at the practice. They told us they were involved in all aspects of their care and found the staff to be caring, friendly and helpful and they were treated with care, dignity and respect.

Our key findings were:

• There were effective processes in place to reduce and minimise the risk and spread of infection.
• Patients’ needs were assessed and care was planned in line with best practice guidance such as from the National Institute for Health and Care Excellence (NICE) .Patients were involved in their care and treatment planning.

• There was appropriate equipment for staff to undertake their duties.
• The practice did not have access to an automated external defibrillator and the medical oxygen cylinder available on the premises was past its use by date.

• Staff were trained in and there was appropriate equipment for them to respond to medical emergencies.
• Patients told us that staff were caring and treated them with dignity and respect.
• Patients indicated that they felt they were listened to and that they received good care from a helpful and caring practice team.
• There were processes in place for patients to give their comments and feedback about the service including making complaints and compliments.
• There were governance arrangements and a management structure in place.
• Updated protocols were not in place as regards maintenance of Control of Substances Hazardous to Health (COSHH) Regulations 2002 folder, handling of sharps, stock control of medicines and equipment, and staff employment.

There were areas where the provider could make improvements and should

• Review staff awareness of the requirements of the Mental Capacity Act (MCA) 2005 and ensure all staff are aware of their responsibilities under the Act as it relates to their role.
• Review the current legionella risk assessment and implement the required actions including the monitoring and recording of water temperatures, taking into acccount guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices and The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance.

• Review it’s responsibilities as regards to the Control of Substance Hazardous to Health (COSHH) Regulations 2002 and, ensure all documentation is up to date and staff understand how to minimise risks associated with the use of and handling of these substances.
• Review availability of medicines and equipment to manage medical emergencies giving due regard to guidelines issued by the Resuscitation Council (UK), and the General Dental Council (GDC) standards for the dental team.
• Review the protocol for completing accurate, complete and detailed records relating to employment of staff. This includes making appropriate notes of verbal reference taken and ensuring proof of identification is requested and recorded.

• Review the practice’s sharps procedures giving due regard to the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013

• Review stocks of medicines and equipment and the system for identifying and disposing of out-of-date stock.

People using the service told us that they were happy with the treatment they had received and way it was provided. "I've been with the practice for 38 years and that speaks for itself". "A very, very good practice".

The procedure for consultation and treatment was fully explained including the fees charged. People were also told about any risks that might arise from treatments chosen.

People felt treated with dignity, respect and had received consultations and treatment in a way that maintained their privacy.

They did not comment on the practice infection control systems. They did tell us they thought the practice was kept clean, tidy and they felt safe using the service.

They were aware of the complaints procedures.

We found that the practice provided suitable information to people for them to make an informed decision whether they wanted to proceed with treatment.

Records were kept up to date and effective infection control and complaints systems were in use.

There were also adequate numbers of suitably qualified staff to meet people's needs.