We carried out an announced comprehensive inspection on 12 September 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

121 Dental Practice is located in the Royal Borough of Kingston and provides private dental services.

The premises consists of a treatment room, a decontamination room and waiting area.

The practice comprises of a principal dentist, a practice manager and a dental nurse.

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

During the inspection we asked patients to complete CQC comment cards. We received 19 comment cards back from patients and spoke with three patients on the day of the inspection. The patients who provided feedback were positive about the care and treatment they received at the practice. They told us they were involved in all aspects of their care and found the staff to be caring, friendly and helpful and they were treated with care, dignity and respect.

Our key findings were:

• There were effective processes in place to reduce and minimise the risk and spread of infection.
• Patients’ needs were assessed and care was planned in line with best practice guidance such as from the National Institute for Health and Care Excellence (NICE) .Patients were involved in their care and treatment planning.
• There was appropriate equipment for staff to undertake their duties and equipment was well maintained.
• Staff were trained in and there was appropriate equipment for them to respond to medical emergencies.
• Patients told us that staff were caring and treated them with dignity and respect.
• Patients indicated that they felt they were listened to and that they received good care from a helpful and caring practice team.
• There were processes in place for patients to give their comments and feedback about the service including making complaints and compliments.
• There were good governance arrangements and an effective management structure.

There were areas where the provider could make improvements and should

• Review it’s responsibilities as regards to the Control of Substance Hazardous to Health (COSHH) Regulations 2002 and, ensure all documentation is up to date and staff understand how to minimise risks associated with the use of and handling of these substances.
• Review the practice’s infection control procedures and protocols taking into account 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 security of prescription pads in the practice and ensure there are systems in place to monitor and track their use.
• Review the protocol for completing accurate, complete and detailed records relating to employment of staff.

• Review staff awareness of the requirements of the Mental Capacity Act (MCA) 2005 and ensure all staff are aware of their responsibilities under the Act as it relates to their role.
• Review the practice’s protocols for the use of rubber dam for root canal treatment giving due regard to guidelines issued by the British Endodontic Society.

• 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 protocols for recording in the patients’ dental care records or elsewhere the reason for taking the X-ray and quality of the X-ray giving due regard to the Ionising Radiation (Medical Exposure) Regulations (IRMER) 2000.

People we spoke with told us they were happy with the level of consultation and information provided to them. One person told us:

"Everything is explained and they make you feel at ease".

After initial contact a consultation took place, people had their treatment options explained to them including why the treatment was needed and given time to consider if they wished to proceed. The reasons why treatment was required was explained using x-rays and practical demonstration. All consultations and treatment took place in private.

We saw that patients are required to complete medical history forms and sign their consent to treatment plans. They are also required to sign their agreement and understanding of the fees involved. This happens after they have received information and advice from the practice manager as well as a consultation from the dentist.

There were effective systems in place to reduce the risk and spread of infection. During our visit a nurse demonstrated the procedures followed with regard to the cleaning and sterilisation of instruments.

We saw that there were adequate numbers of staff to meet people's needs. They had access to appropriate training and were suitably qualified for the posts they held. We saw evidence of qualifications for the dental nurse and evidence of continuing professional development of the dentist. The practice manager worked closely with the dentist and dental nurse to ensure that patients were appropriately treated.