We carried out an unannounced comprehensive inspection on 14 February 2017 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

Vidadent Practice located in Bethnal Green London provides private dental treatment to patients of all ages.

Practice staffing consists of the principal dentist, three associate dentists, one dental nurse and a practice manager.

The practice manager has submitted an application to the Care Quality Commission (CQC) for the registered manager position. A registered manager is a person who is registered with the 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.

The practice is open Monday to Sunday 10am to 8pm

The practice facilities include two treatment rooms a decontamination room, reception/waiting area, and a staff room/kitchen.

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

Our key findings were:

• 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).

• The practice sought feedback from patients about the services they provided and acted on this to improve its services.
• The practice had a procedure for handling and responding to complaints, which were displayed and available to patients.
• Equipment, such as the autoclaves, fire extinguishers and compressor had all been checked for effectiveness and had been regularly serviced.
• Patients received clear explanations about their proposed treatment, costs, benefits and risks and were involved in making decisions about it.
• Patients were treated with dignity and respect and confidentiality was maintained.
• Infection control protocols were being followed in line with recommended national guidance.
• The practice had not ensured that all the specified information relating to persons employed at the practice was obtained and appropriately recorded.
• Governance systems required improvement to ensure audits were undertaken regularly and were used to drive improvements .
• Staff we spoke with were aware of the safeguarding 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. Improvements were required to ensure all staff had received formal safeguarding children and adults training.

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

• Review the practice's policy and the storage of products identified under Control of Substances Hazardous to Health (COSHH) 2002 Regulations to ensure a risk assessment is undertaken and the products are stored securely.

• Review stocks of medicines and equipment and the system for identifying and disposing of out-of-date stock.
• Review the practice’s safeguarding staff training 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 the practice’s audit protocols of various aspects of the service, such as infection control at regular intervals to help improve the quality of service.

We did not speak to patients as part of this inspection because we were examining dental and staff records. At our last inspection in October 2013 we found that patients' dental records were not accurate and fit for purpose. They did not contain detailed information about the treatment carried out and advice given.

During this visit we found evidence that patient records were accurate and being maintained. Staff had been trained in record keeping and audits carried out which had resulted in improvements in the standard of patient record keeping. The practice had implemented a new patient record form and when we reviewed patient records we found they contained detailed information about treatment, patient advice and recall intervals.

At our previous inspection of Vivadent Practice on 12 June 2013 we were concerned that staff were not adequately supported to deliver care to an appropriate standard. People’s privacy, dignity and independence were not always respected due to the shared treatment area.

There were concerns about the way instruments were cleaned and sterilised. The information given to us by staff about the decontamination process and the lack of hand washing facilities raised concerns in terms of health and safety and infection control.

We asked the provider to send us a report by 26 September 2013, setting out the action they will take to meet the standards. We have taken enforcement action against Vivadent Practice to protect the health, safety and welfare of people using the service.

We carried out a follow up inspection on 10 October 2013. We found the provider had met some of the standards identified in our previous inspection. The provider had effective systems in place to regularly assess and monitor the quality of service that people receive. The provider had employed an additional member of the dental nursing staff to allow each dentist to work with an allocated dental nurse for the duration of their appointments each day.

We found that the provider had made changes to meet of the standards identified in our previous inspection which had caused concern relating respecting people’s privacy, dignity and independence, supporting staff and infection control.

We also noted that people’s personal records including medical records were not accurate or detailed enough.

We spoke with three people who all said they were happy with the service they received from Vivadent Practice.

Staff we spoke with said they felt supported in their role. We did not see any evidence of staff supervision or team meetings being carried out. The practice used trainee dental nurses to assist the dentists. There were no qualified dental nurses employed at the practice. It is possible people were cared for by staff who were not adequately supported to deliver care to an appropriate standard.

The treatment room was divided into two areas and did not allow for patients to be treated in complete privacy.

There were concerns about the way instruments were cleaned and sterilised. The information given to us by staff about the decontamination process and the lack of hand washing facilities raised concerns in terms of health and safety and infection control at the practice.