We carried out this announced inspection on 9 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

W S Kwan Dental Surgery is in the London Borough of Barnet and provides private treatment to adults.

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

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 21 CQC comment cards filled in by patients.

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

• The practice is open: Monday, Tuesday, Wednesday and Friday 9am to 4pm

• Saturday 9am to 1pm

Our key findings were:

• The practice appeared clean and well maintained.
• 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 practice was providing preventive care and supporting patients to ensure better oral health.
• 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. Improvements were needed to ensure infection control audits are carried out at regular intervals

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

• Review the current infection control protocols and undertake a Legionella risk assessment and implement the required actions taking into account guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices and have regard to The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance.’
• 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 the practice’s protocols for the use of rubber dam for root canal treatment taking into account guidelines issued by the British Endodontic Society.
• Review the practice’s audit protocols to ensure infection control audits are undertaken at regular intervals, and where applicable learning points are documented and shared with all relevant staff.

During our inspection on 2 July 2013 we found non-compliance with standards relating to cleanliness and infection control. Hazardous cleaning products were not securely stored and dental disinfectant cleaner used to clean dirty instruments was kept in a sharps container in an unlocked cupboard. Regular audits did not take place in accordance with the Department of Health, Health Technical Memorandum 01-05 (HTM01-05). This meant that people could not be sure they were protected from the risk of acquiring a healthcare acquired infection.

At this inspection we found that the dentist had made some improvements. On this occasion we did not speak to patients, but we observed that the surgery was clean and noted the improvements. A recent decontamination and infection control audit using HTM01-05 self-assessment had been carried out by the dentist.

Care and treatment was planned and delivered in a way that was intended to ensure people’s safety and welfare. Patients we spoke with were positive about the quality of care and treatment received. One patient commented "I’ve been to many dentists over the years, he is fantastic.”

We spoke with four patients who spoke highly of the dental practice. They told us they 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, “he (the dentist) is always polite and very gentle.” Patients 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 regular decontamination audits did not take place in accordance with the Department of Health, Health Technical Memorandum (HTM01-05) requirements. This meant that people could not be sure they were protected from the risk of acquiring a healthcare acquired infection.