We carried out this unannounced inspection on 19 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 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

Align and Smile is in the London Borough of Tower Hamlets and provides NHS and private treatment to adults and children.

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

The dental team includes five dentists, two orthodontist (one of whom is the principal dentist), one endodontist, one periodontist, four dental nurses, one dental hygienist, three dental hygiene therapists, three receptionists and an administrator. The practice has five 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 Align and Smile Limited is the principal dentist.

On the day of inspection we spoke with three patients.

During the inspection we spoke with a dentist and the principal dentist, a dental nurse, the dental hygienist, and the administrator. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday - Thursday 9.am - 7.30pm

Friday – 9.am – 5.pm

Our key findings were:

• The practice appeared clean and well maintained.
• The provider 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 to patients and staff.
• The practice staff had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
• The provider 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 provider was providing preventive care and supporting patients to ensure better oral health.
• The appointment system met patients’ needs.
• The practice had effective leadership and 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.
• The provider dealt with complaints positively and efficiently.
• The provider had suitable information governance arrangements.

There were areas where the provider could make improvements. They should:

Review stocks of medicines and equipment and the practice's system for identifying, disposing and replenishing of out-of-date stock.

Review staff training to ensure that all the staff have received training, to an appropriate level, in the safeguarding of children and vulnerable adults.

Review the practice’s systems for assessing and monitoring risks in relation to fire and legionella. In particular, review the fire risk assessment regularly. Also, ensure that any recommendations identified on the legionella risk assessment are actioned and documented as completed.

Review the practice’s systems for assessing, monitoring and mitigating the various risks arising from when the dental hygienists work without chairside support.

Review the practice's protocols and procedures for the use of X-ray equipment in compliance with The Ionising Radiations Regulations 2017 and Ionising Radiation (Medical Exposure) Regulations 2017 and taking into account the guidance for Dental Practitioners on the Safe Use of X-ray Equipment.

We carried out an announced comprehensive inspection on 19 July 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

Align and Smile Limited located in Tower Hamlet provides a mix of NHS and private dental treatment including oral surgery, general dentistry, endodontics and periodontics and the placement of dental implants. The practice also provides under contract with NHS England orthodontics and minor oral surgery services.

Practice staffing consists of the principal dentist, four associate dentists, two orthodontists, one oral surgeon, one endodontist, one Hygienist, seven dental nurses, two receptionists, one assistant practice manager and the practice manager,

The principal dentist 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 practice is open Monday, Wednesday and Friday 9.00am to 5.30pm, Tuesday and Thursday 9.00am to 7.30pm.

The practice facilities include four treatment rooms, two reception and waiting areas, consultation room, decontamination room, one office and a staff room/kitchen.

65 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.
• Staff had been trained to handle medical emergencies, and appropriate medicines and life-saving equipment were readily available.
• We found the dentists regularly assessed each patient’s gum health and took X-rays at appropriate intervals.
• There were systems in place to reduce the risk and spread of infection. Dental instruments were cleaned and sterilised in line with current guidance.
• There were systems in place to ensure that all equipment was maintained in line with manufacturer’s guidelines.
• The practice ensured staff were trained and that they maintained the necessary skills and competence to support the needs of patients.
• Patients were treated with dignity and respect and confidentiality was maintained.
• Patients received clear explanations about their proposed treatment, costs, benefits and risks and were involved in making decisions about it.
• Governance systems were effective and there were a range of policies and procedures in place which underpinned the management of the practice.
• The practice sought feedback from staff and patients about the services they provided and acted on this to improve its services.
• The practice had not carried out an audit in a key area, such as radiography.
• The practice had a procedure for handling and responding to complaints, which were displayed and available to patients. However improvements could be made to establish an accessible system for identifying, receiving, recording, handling and responding to complaints by patients.

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

• Review its audit protocols to ensure radiography audits are undertaken at regular intervals, and where applicable learning points are documented and shared with all relevant staff.
• Review its complaint handling procedures and establish an accessible system for identifying, receiving, recording, handling and responding to complaints by patients.

Patients were happy with the service at Align and Smile Limited. They praised the friendliness of the staff and the information they received about their care and treatment. Patients told us they had enough information about the costs of treatment, they were able to ask questions and were offered choices about their treatment.

We saw that the service was clean and hygienic with effective systems to decontaminate equipment and instruments. The dentists assessed people's medical history before providing treatment, sought written consent when appropriate and kept clear records of people's treatment plans. The service was equipped to deal with medical emergencies.

The dentists and clinical staff members were qualified and had opportunities to develop professionally. Staff members were positive about the service and the support they received from colleagues.