We carried out this announced inspection on 24 April 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

Winchmore Hill Dental Practice is in the London Borough of Enfield and provides private treatment to adults and children.

Car parking spaces are available near the practice.

The dental team includes the principal dentist, three associate dentists, two dental hygienists, three dental nurses, a visiting sedationist, a receptionist and practice manager. The practice has three treatment rooms, a decontamination room, a X-ray room, reception/waiting area and staff room

The practice is owned by a company and as a condition of registration must have a person registered with the Care Quality Commission as the registered manager. Registered managers 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 registered manager at Winchmore Hill Dental Practice was the practice manager.

On the day of inspection we collected 18 CQC comment cards filled in by patients.

During the inspection we spoke with one dentist, two dental nurses, one dental hygienist and the practice manager. We looked at practice policies and procedures and other records about how the service is managed.

Our key findings were:

• The practice appeared clean and well maintained.
• The practice had infection control procedures which reflected published guidance.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• The practice had systems to help them manage risk. Improvements could be made to make sure all equipment is maintained according to guidance.
• 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 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.

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

• Review the fire safety risk assessment to ensure that this is carried out in line with current guidance.
• Review the practice's systems for checking and monitoring equipment taking into account relevant guidance and ensure that all equipment is well maintained.
• Review the practice's protocols and procedures for the use of X-ray equipment in compliance with The Ionising Radiations Regulations 2017 and Ionising Radiation (Medical Exposure) Regulations 2017 and taking into account HPA-CRCE-010 Guidance on the Safe Use of Dental Cone Beam (Computed Tomography).
• Review staff training to ensure that dental nursing staff who assist in conscious sedation have the appropriate training and skills to carry out the role, taking into account guidelines published by The Intercollegiate Advisory Committee on Sedation in Dentistry in the document 'Standards for Conscious Sedation in the Provision of Dental Care 2015'.

• Review its responsibilities to meet the needs of people with a disability, including those with hearing difficulties and the requirements of the Equality Act 2010.

We did not speak with patients as the focus of the inspection was to check that specific improvements had been made by the provider.

Patients were protected from the risks of abuse. Staff were aware of patient safety and child protection policies and procedures. Staff had recently completed safeguarding vulnerable adults and children training. Staff knew how to recognise abuse and to report any allegations of abuse to the manager, the local authority and police as necessary.

Patient’s records were stored securely and retained for no longer than is necessary. Policies and procedures for the management of the practice had been tailored to the needs of the practice, reviewed and updated and brought to the attention of staff.

Patients told us that treatment was explained to them by staff in the surgery in private, that they were given choices of treatment and costs. Patients were able to express their views and were involved in making decisions about their care and treatment. One patient commented “I leave with a clear understanding of what work was done and what needs to be done."

We spoke with staff and saw records that showed care and treatment was planned and delivered in line with their individual treatment plan. Patients were recalled at intervals based on their individual needs. One patient said “the dentist is very good, I visit him when I am in this country.”

We saw that the provider had patient safety and child protection policies and procedures. Some staff were aware of the policy and knew to report any allegations of abuse to the provider, but not for contacting the local authority and police as necessary.

The premises were clean and well maintained. The provider told us and we saw that refurbishment works were in progress to provide upgraded surgeries and a separate decontamination room. We saw that audits had been carried out by the provider to monitor infection control guidelines as detailed in Department of Health Technical Memorandum 01-05 (HTM 01- 05).

We saw that patients' personal records including medical records were kept up to date. Records were not retained and stored in accordance with the Data Protection Act 1998.