We carried out this unannounced inspection on 12 July 2017 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.

We told the NHS England area team that we were inspecting the practice and they shared some information with us.

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

349-351 Brockley Road is a dental practice in the London Borough of Lewisham and provides NHS and private treatment to patients of all ages.

There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces are available near the practice.

The dental team includes 12 dentists, 12 dental nurses, two dental hygienists, four receptionists, one practice manager and a general manager. The practice has ten treatment rooms.

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 349-351 Brockley Road was the principal dentist.

On the day of inspection we spoke with three patients and looked at feedback in their comments book. This information gave us a positive view of the practice.

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

The practice is open:

Monday & Tuesday 9: am-9: pm.

Wednesday –Friday 9: am -6: pm.

Saturday 9: -1: pm.

Our key findings were:

• The practice was 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 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 appointment system met patients’ needs.
• The practice had effective leadership. 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.
• Recommendations from a fire risk assessment that was completed in April 2015 that needed to be actioned immediately had not been acted upon.

The provider was made aware of our findings on the day of the inspection and they were formally notified of our concerns immediately after the inspection. They were given an opportunity to put forward an urgent action plan with remedial timeframes, as to how the risks could be mitigated.

The provider responded appropriately within the required time frame to inform us of the urgent actions they had undertaken to mitigate the risks. These included voluntary cessation of the provision of dental care services at the location till urgent remedial steps were put in place.

At our inspection we spoke with five patients. They were happy with the quality of the services provided. We saw evidence that when people made suggestions or raised issues staff responded and implemented changes to improve the quality of the environment and services.

Staff spoke with patients in a professional and obliging way, and patients told us that the staff were helpful and friendly, polite, provided them with appointments at convenient times and explained their treatment options. Most patients were satisfied with the treatment options, fees and dental staff. One patient said, “I have had the same dentist for years, she is very good”. Another said, “I am a satisfied customer with over 30 years experience of coming here”.

Patients told us the practice and its staff were clean, neat and hygienic. We found there were appropriate cross-infection and decontamination policies and practices in place. Patient areas were visually clean, fresh and well-organised, but we saw a few areas, such as staff room floor coverings, which presented a risk of cross-infection. The provider told us that these surfaces would be repaired within a month.

Although there were child and adult protection policies in place, and staff understood and followed the policies, only 30% of staff had undertaken formal safeguarding and protection training, and the policies required updating as they did not refer to the local authority’s safeguarding policy and other relevant legislation.