We carried out an announced comprehensive inspection on 26 July 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

Vaswani Dental Practice located in Southgate provides private dental treatment to patients of all ages and NHS treatment for children.

Practice staffing consists of the dentist one dental nurse and one trainee dental 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.

The practice is open Monday to Friday 10am to 6pm and Saturdays 9am to 2pm.

The practice facilities include one treatment room, a reception/waiting area and staff room

15 patients provided feedback about the service. Patients we spoke with and those who completed comment cards were very positive about the care they received about the service. Patients told us that they were happy with the treatment and advice they had received.

Our key findings were:

• Staff had received safeguarding children and adults training and knew the processes to follow to raise any concerns. The practice had whistleblowing policies and procedure and staff were aware of these and their responsibilities to report any concerns.
• Patients were treated with dignity and respect and confidentiality was maintained.
• 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).
• We found the dentists regularly assessed patient’s gum health and took X-rays at appropriate intervals.
• Patients received clear explanations about their proposed treatment, costs, benefits and risks and were involved in making decisions about it.
• The practice had a procedure for handling and responding to complaints, which were displayed and available to patients.
• There were systems in place to reduce the risk and spread of infection. Dental instruments were cleaned and sterilised in line with current guidance. However a legionella risk assessment had not been carried out.
• Rubber dam was used in all root canal treatments.
• Staff had been trained to handle medical emergencies, and appropriate medicines and oxygen were readily available. However the practice did not have an automated external defibrillator (AED).
• The practice did not have a structured plan in place to audit radiography or dental care records
• There were some governance arrangements in place for the smooth running of the practice. However the practice did not have a structured plan in place to monitor quality and safety. The practice had not effectively monitored and mitigated the risks associated with carrying out the regulated activities.

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

• Review availability of 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 practice’s responsibilities as regards to the Control of Substances Hazardous to Health (COSHH) Regulations 2002 and, ensure all documentation is available and staff understand how to minimise risks associated with the use of and handling of these substances.
• Review its audit protocols to ensure audits of various aspects of the service, such as radiography and dental care records are undertaken at regular intervals to help improve the quality of service. The Practice should also ensure that where appropriate audits have documented learning points and the resulting improvements can be demonstrated.

We spoke individually with three patients. They understood the care and treatment choices available to them. One patient told us “the dentist answers my questions very thoroughly” whilst another remarked “I feel comfortable asking questions and I’m happy with the responses.”

We were told that patient appointments were followed up between three to twelve months, depending upon treatment complexity and the needs of the individual patient.

The dentist told us that during appointments they did not proceed straight to the treatment but would routinely converse with the patient. They told us that this initial conversation (particularly with elderly patients) was an opportunity to identify any possible safeguarding issues.

Staff could also explain the process to be followed to ensure that dental instruments were properly cleaned. This included the use of an ultrasonic machine to clean instruments and an autoclave machine to sterilise the cleaned instruments.

The provider was able to evidence that patient’s paper records indicated when a patient’s medical condition might impact on dental treatment. We were told that this was also highlighted on the patient’s electronic record. It meant that the provider had accurate records to help identify and manage risks in relation to providing dental care.

We were able to speak to patients of the dental practice. They indicated that they had been treated with respect and dignity. They expressed satisfaction with the care and treatment provided. The practice has a policy for ensuring that all patients are treated with respect and dignity.

Patients made positive comments about staff and indicated that they had confidence in the dentists and other staff who attended to them. Detailed assessments and treatment plans had been prepared for patients. Treatment had been given with patients’ agreement and written consent.

Patients’ views can be summarised by the following comments:

“The dentist is friendly and kind”.

“I’m very happy with the care and attention to me and my teeth”.

“He (the dentist) always explains exactly what he is doing”.

The premises were clean and well maintained. There are arrangements for infection control checks and daily cleaning tasks. Staff were knowledgeable regarding infection control and decontamination procedures for equipment and instruments used. There was documented evidence that equipment used had been maintained and inspected by specialist contractors.