We carried out this announced inspection on 10 July 2018 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.

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

Vivian Avenue Dental Clinic is in the London Borough of Barnet and provides private treatment to adults.

The dental team includes the principal dentist, one dentist, one dental nurse and two trainee dental nurses.

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 27 CQC comment cards filled in by patients.

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

The practice is open:

• Monday to Friday 9am to 6pm

• Occasional Saturday 9am to 6pm

Our key findings were:

• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were 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 and a culture of continuous improvement.
• 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 practice had suitable information governance arrangements.
• The practice had infection control procedures which reflected published guidance.

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

• Review the current Legionella risk assessment and implement the required actions including the monitoring and recording of water temperatures.
• Review the fire and health and safety risk assessments to ensure all identified risks are monitored and mitigated and all actions are completed promptly.
• Review the practice's protocols for completion of dental care records taking into account guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.

During our inspection on 7 May 2013 we found this service non-compliant with safeguarding protocols and standards relating to cleanliness and infection control. Safeguarding policies and procedures were not updated and staff had not received training. The decontamination area did not show clear signs for clean and dirty cycles and hand washing facilities were inadequate. Clinical waste was stored in bags in an unlocked area at the back of the practice.

We found that the dentist had made the necessary improvements. We did not speak to patients, but we observed that the surgery was clean and noted the improvements. Safeguarding policies and procedures had been updated and clear guidance provided for staff. We saw evidence that all staff had received recent safeguarding training, including the Mental Capacity Act 2005 (MCA). Infection control policies and procedures had been updated. Most staff had received up to date training in decontamination and infection control and a recent infection control audit using the Department of Health, Health Technical Memorandum 01-05 (HTM01-05) self-assessment completed and acted on. A hand sanitiser had been installed in the toilet and clinical waste stored in a locked shed at the back of the practice.

Patients told us they had been treated with respect and dignity. They were well-informed about their treatment plans which they said they had contributed to at every stage. Patients told us they had been given information to assist their decisions regarding treatment, including costs and treatment options.

We spoke with four patients who spoke highly of the dental practice. They told us they were treated with respect and felt involved in their care and that they were given appropriate information by the dentist, which enabled them to make choices about their treatment. One patient commented, “she (the dentist) is very, very good.” Another said, “I recommended the dentist to a relative who now comes here.” The patients confirmed they had no concerns about their dentist but were confident to speak to the dentist if they felt they needed to.

There were systems in place for infection control and dealing with foreseeable emergencies, however we were concerned that clinical waste was not kept in a secure area and the lack of hand washing facilities in the toilet area. Although current records relating to patients were kept in a lockable cabinet, we were concerned that archived records were not kept securely and safely.