We carried out an announced comprehensive inspection on 18 November 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

West Norwood Dental Surgery is a NHS dental practice in Lambeth. The practice is situated in a converted residential property. The practice is set out over two floors and has one dental treatment room, a patient waiting room with reception, a separate decontamination room for cleaning, sterilising and packing dental instruments and a staff office.

The practice is open 10.00am to 3.00pm Monday, Wednesday and Thursdays. The practice is also open on Tuesday and Fridays for administration purposes although if a patient had a dental emergency they would be seen on these days.

The practice staffing consisted of one dentist and a dental nurse.

The principal dentist is registered with the Care Quality Commission (CQC) as an individual ‘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.

Before the inspection we sent Care Quality Commission comment cards to the practice for patients to complete to tell us about their experience of the practice. We received feedback from 49 patients via completed comment cards. Patients provided a positive view of the services the practice provides. They commented on the quality of care, the friendliness and professionalism of all staff, the cleanliness of the practice and the overall quality of customer care.

Our key findings were:

• Both staff had been trained to handle emergencies and appropriate medicines and life-saving equipment was readily available in accordance with current guidelines. Some of the recommended equipment however was not available.
• The practice appeared clean and well maintained.
• Infection control procedures were in place however audits were not being completed.
• The principal dentist was the safeguarding lead.. Both staff members demonstrated knowledge of safeguarding.
• The practice had a system in place for reporting incidents which the practice used for shared learning.
• The dentist provided dental care in accordance with current professional and National Institute for Health and Care Excellence (NICE) guidelines.
• Governance arrangements were in place however not all risks associated with carrying out regulated activities were being considered.
• The service was aware of the needs of the local population and took these into account in how the practice was run.
• Patients could access treatment and urgent and emergency care when required.
• Staff recruitment files were in order and included relevant pre recruitment documents such as, CVs and references.
• Staff had the opportunity to attend learning and training events.
• The dental nurse we spoke with felt well supported by the practice owner and both staff members were committed to providing a quality service to their patients.
• Feedback from patients gave us a positive picture of a friendly, caring and professional service.

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

• Review governance arrangements to ensure there are effective systems established to assess, monitor and mitigate the various risks arising from undertaking of the regulated activities, including the storage of dental care records. Review availability of equipment and staff training 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 infection control procedures including assessment of legionella and protocols giving due regard to guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices and The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance.
• Review the practice's protocols for completion of dental records giving due regard to guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.
• Review the practice’s audit protocols of various aspects of the service, such as radiography and dental care records at regular intervals to help improve the quality of service. Practice should also check, where applicable audits have documented learning points and the resulting improvements can be demonstrated.

We did not speak to people using the service during our inspection as there were no patient appointments booked on that day. However, we did review patient satisfaction questionnaires and read feedback comments that patients had left.

We looked at seven patient records during our inspection; we saw evidence that proposed treatment plans and the cost of treatment were recorded.

There were arrangements in place to deal with foreseeable emergencies. Portable oxygen, a first aid and an emergency drugs box were available at the practice. Medication was within the use by date and the oxygen was checked on a weekly basis.

We spoke with the dental nurse about the cleaning procedure they followed at the practice and observed them while they showed us the process used for sterilising used instruments. The nurse told us that they followed a checklist to maintain cleanliness at the beginning of the day and in between patients.

The dentist showed us evidence confirming that they completed the required number of hours to maintain their registration with the General Dental Council (GDC).