We carried out an announced comprehensive inspection on 26 May 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

2 Green Dental is located in the London Borough of Bexley. The premises are situated in a converted residential building, adjacent to a parade of shops. There are six treatment rooms, a decontamination room, an X-ray room, reception and waiting areas, and patient toilets across the ground, first and second floors of the building.

The practice provides NHS and private services to adults and children. The practice offers a range of dental services including routine examinations and treatment, veneers and crowns and bridges. The practice also offers a full range of specialist treatments including implants, root canal treatments, and oral hygiene.

The staff structure of the practice consists of two principal dentists, two associate dentists, one trainee dentist, three hygienists, six dental nurses and four receptionists. There is also a visiting oral surgeon for complex extraction cases.

The practice opening hours are on Monday, Thursday and Friday from 9.30am to 5.00pm, and on Tuesday and Wednesday from 8.30am to 6.00pm. The practice is also open from 9.00am to 1.00pm on Saturdays.

One of the principal dentists is the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘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.

The inspection took place over one day and was carried out by a CQC inspector and a dental specialist advisor.

Seven people provided feedback about the service. Patients were positive about the care they received from the practice. They were complimentary about the friendly and caring attitude of the dental staff.

Our key findings were:

• Patients’ needs were assessed and care was planned in line with current guidance such as from the National Institute for Health and Care Excellence (NICE).

• There were effective systems in place to reduce and minimise the risk and spread of infection.
• The practice had effective safeguarding processes in place and staff understood their responsibilities for safeguarding adults and children living in vulnerable circumstances.
• Staff reported incidents and kept records of these which the practice used for shared learning.
• There were effective arrangements in place for managing medical emergencies.
• Equipment, such as the air compressor, fire extinguishers, and X-ray equipment had all been checked for effectiveness and had been regularly serviced.
• Patients indicated that they felt they were listened to and that they received good care from a helpful and caring practice team.
• The practice ensured staff maintained the necessary skills and competence to support the needs of patients.
• The practice had implemented clear procedures for managing comments, concerns or complaints.
• The provider had a clear vision for the practice and staff told us they were well supported by the staff team.
• Governance arrangements and audits were effective in improving the quality and safety of the services.

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

• Review the systems for checking and monitoring equipment to ensure that all equipment is well maintained.
• Review the practice’s waste handling procedure to ensure waste, or other out-of-date products, are disposed of in accordance with relevant regulations giving due regard to guidance issued in the Health Technical Memorandum 07-01 (HTM 07-01).
• Review recruitment procedures to ensure accurate, complete and detailed records are maintained for all staff.

We carried out this announced inspection on 25 September 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 Care Quality Commission (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

2 Green Smile LTD, trading as 2 Green Dental is based in the London Borough of Bexley and provides NHS and private treatment to patients of all ages.

There is level access on the ground floor for people who use wheelchairs and those with pushchairs.

The clinical team includes two principal dentists, three associate dentists, three dental hygienists, five qualified dental nurses and two trainee dental nurses. The clinical team is supported by four receptionists and three administrators (both of whom occasionally also undertook receptionist and dental nursing duties).

The practice has six treatment rooms. There is a dedicated decontamination facility.

The practice is owned by an organisation, 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 2 Green Smile LTD, trading as 2 Green Dental was one of the principal dentists.

On the day of inspection, we obtained feedback from 11 patients.

During the inspection we spoke with the principal dentist, a dental nurse, and two administrators. We checked practice policies and procedures and other records about how the service is managed.

The practice is open at the following times:

• Monday, Thursday, Friday 09.30-13.00, 14.00-17.00
• Tuesday, Wednesday 08.30-13.00, 14.00-18.00
• Saturday 09.00-13.00

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.
• 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.
• Feedback we received from patients about the service was positive.
• The practice dealt with complaints positively and efficiently.
• The practice had suitable information governance arrangements.

There are areas where the practice could make improvements. They should:

• Review arrangements for tracking and monitoring the use of prescription pads, antibiotics and analgesics.
• Review the practice’s protocols for ensuring that all clinical staff have adequate immunity for vaccine preventable infectious diseases.
• Review staff training to ensure that all staff undertake outstanding relevant training in dental radiography.