We carried out this unannounced inspection on 27 November 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.

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

A A Tikare & Associates is in Gravesend and provides NHS and private treatment to patients of all ages.

There is no level access for people who use wheelchairs and pushchairs and access to the treatment rooms is via a flight of stairs. The practice refers patients who cannot manage the stairs to a practice in the vicinity with level access.

The dental team includes three dentists, one student dental nurse, one dental hygienist, a practice manager and one receptionist. The practice has four treatment rooms.

The practice is owned by an individual who is the principal dentist there. They have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run.

On the day of inspection we did not issue or collect CQC comment cards as this was an unannounced inspection. We spoke with four patients. This information gave us a positive view of the practice. However patients did comment that they sometimes had problems accessing the service.

During the inspection we spoke with two dentists, one student dental nurse, one agency dental nurse, one receptionist 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 to Friday 9am to 5.30pm

Saturdays by appointment only

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 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 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.

There were areas where the provider could make improvements.

They should: review staffing levels particularly on reception.

Patients were given appropriate information and support regarding their care or treatment. Patients we talked with were very complimentary about the staff, the service and the treatment they had received. Patients said "The dentist explained treatments to me, the dentist was very understanding and I am very happy with this dentist”. Other patients commented that the staff were “Pleasant, caring and excellent."

We found that patient's needs were assessed and care and treatment was planned and delivered in line with their individual treatment plan. Patients spoke positively about the practice.

Patients were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

We found that the registered person was taking reasonable steps to prevent abuse from happening because they had effective systems in place to recruit, train and inform employees about safeguarding issues and that the systems were underpinned by policies and procedures that were reviewed.

We found that the registered person had effective infection control procedures in place; Policies and procedures covered all areas of infection control from the decontamination process of the dental instruments to the practice environment to staff uniforms and personal protective equipment (PPE).

We found that the service regularly assessed and monitored the quality of the service provided. Patients and their representatives were regularly asked for their views and these were collated and analysed; the results were used to inform business improvement and patient experiences.

People told us that they were happy with the service provided. They said they were given enough information about treatment options and were able to ask all the questions they wanted to. People told us that they found the staff to be friendly and said that they were treated with respect and their privacy was protected. They said that appointments were flexible to meet their needs and the surgery was clean and comfortable.