We carried out an announced comprehensive inspection on 26 October 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

Alba Dental Care located in Tower Hamlet provides NHS and private dental treatment to patients of all ages.

Practice staffing consists of the two principal dentist, two dental nurses and a receptionist.

The principal dentists are registered with the Care Quality Commission (CQC) as individual 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 practice is open Monday to Friday 9am to 5pm.

The practice facilities include two treatment rooms, a reception and waiting area for patients, a decontamination room and an office and kitchen area.

Fifteen patients provided feedback about the service. Patients we spoke with and those who completed comment cards were very positive about the care they received about the service. Patients told us that they were happy with the treatment and advice they had received.

Our key findings were:

• Staff had received safeguarding children and adults training and knew the processes to follow to raise any concerns. The practice had whistleblowing policies and procedure and staff were aware of these and their responsibilities to report any concerns.
• Equipment, such as the autoclaves, fire extinguishers, and X-ray equipment had all been checked for effectiveness and had been regularly serviced.
• Patients were treated with dignity and respect and confidentiality was maintained.
• There were systems in place to reduce the risk and spread of infection. Dental instruments were cleaned and sterilised in line with current guidance.
• Patients received clear explanations about their proposed treatment, costs, benefits and risks and were involved in making decisions about it.
• 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).
• The practice had a procedure for handling and responding to complaints, which were displayed and available to patients.
• Staff had been trained to handle medical emergencies, However not all appropriate medicines were readily available
• Governance systems were effective and there were a range of policies and procedures in place which underpinned the management of the practice.

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

• Review its responsibilities as regards 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 protocols for the use of rubber dam for root canal treatment taking into account guidelines issued by the British Endodontic Society.

At our last inspection in September 2013 we found that care and welfare was not always planned and delivered in a way to ensure patients' safety. Records did not always contain evidence that patients' medical histories had been reviewed and updated at each visit. We also found that staff were not adequately supported because they did not have formal supervision and appraisal meetings.

During this visit we found there was a system in place to ensure patients’ medical histories were reviewed, updated and documented at each visit to the dental surgery. Patient records we examined confirmed this.

There was evidence in staff training records to demonstrate that regular supervision and appraisal meetings were taking place. Personal development plans had been structured and agreed with staff.

People we spoke with were happy with their care and treatment. One person said “they are excellent here, everything is fully explained.”

People liked the practice because treatment options were explained and they had time to discuss their treatment with the dentist.

It was noted when looking at a sample of treatment records that some people using the service had not had their medical history reviewed at their last appointment. This meant there was a risk to people using the service as they were being treated without the provider knowing their medical conditions or identifying any potential risks treatment might pose to their health.

We found there were no systems in place to provide staff with formal supervision and appraisals. All staff were trained to undertake their roles.

The practice was clean and well maintained.