Our inspection of 27th November 2012 found that people were at risk of receiving unsafe care, treatment and attention because there was insufficient staff to meet the needs of people who use the service. People who use the service were not fully protected from the risk of abuse, because the provider had not taken reasonable steps to help staff identify the possibility of abuse and staff were unaware of how to report potential abuse. We found there was a lack of effective auditing, meaning that people were at risk from unsafe equipment and systems being used beyond their maintained contract. The provider wrote to us and told us they would make changes within three months by reviewing staff levels, providing staff training and auditing procedures. We found improvements had been made.

We spoke with three staff who confirmed they had attended a combined workshop covering safeguarding of vulnerable adults and child protection. We saw certificates indicating the date that staff attended these workshops.

We asked about arrangements for dental nurse cover when more than one surgery was in use. We were told by the dentist and administrative staff that requests for additional nursing staff had been explored and three nurses had been contacted to cover a range of shifts.

We spoke with the provider who explained the audit procedures that staff carried out, including checks made of expiry dates of medication in the emergency first aid drug box and life support equipment.

We spoke with five people who were registered with the dentist and people told us that they were satisfied with the service that they received from Twickenham Dental Care. One person told us that they had been using the practice for many years and were happy; another person said “I’m very happy here we have been using the service for some time and everyone is very professional”.

One couple said “we are treated very well here and we trust the dentist who treats us, the staff are always friendly and helpful”.

We saw that people were treated in private rooms and had their dignity respected. The fees and treatments were clearly explained to people and they were given a choice of treatments, where applicable, with a range of options and any treatment risks fully clarified.

The clinic reception and treatment rooms looked clean and well maintained. The layout of some areas used for decontamination purposes however, did not take into account some contamination risks.

The service records for one piece of equipment were out of date and we found that the practice was not always using audit processes to monitor the safety of its service.

Some staff working at the practice had documents showing that they had received Criminal Record Bureau clearance, while others had not.