We carried out this announced inspection on 9 March 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

All Smiles in Finchley located in Barnet provides private dental treatment to patients of all ages.

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

Practice staffing consists of a principal dentist and one trainee dental nurse.

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.

The practice is open Tuesday and Friday 9am to 6pm.

The practice facilities include one treatment room, two decontamination rooms, reception/waiting area and staff room.

On the day of inspection we collected feedback from 15 patients. This information gave us a positive view of the practice.

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

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 dealt with complaints positively and efficiently.

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

• Review the practice's environmental risk assessments and ensure a fire risk assessment is undertaken and the necessary actions implemented.

This visit was a follow up to our inspection of the practice on 30 December 2013.

We had found that whilst staff were up-to-date with emergency care and resuscitation training not all emergency equipment was available or working. Also, medicines listed in the UK Resuscitation Council equipment list for cardiopulmonary resuscitation (CPR) in primary dental care were unavailable at the practice. This meant that there was a risk that staff may have been unable to respond effectively to a patient emergency.

Following our inspection in December 2013 we required the practice to send us a plan of the actions intended to meet the requirements of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We carried out this visit to check that improvements had been implemented.

We found the practice had taken appropriate action and was now compliant with the regulation.

Patients who used the service understood the care and treatment choices available to them. We spoke with five patients during the inspection. They told us they were treated with respect. We saw the dentist and the dental nurse spoke to patients respectfully and welcomed them when they arrived. One patient said, "ten out of ten for the service and treatment.” Another said, “staff are kind and listen to me and my worries.”

We saw staff were up-to-date with emergency care and resuscitation training. Not all emergency equipment was available or working. This meant that there was a risk that staff may have been unable to respond effectively to a patient emergency.

Patients we spoke with were happy with the level of cleanliness at the practice. One patient said, “Its clean here (the dental surgery) otherwise I would not come.” Another said, “It’s spotlessly clean, I see the dentist washing her hands.”

Appropriate checks were undertaken before staff began work. Patients we spoke with felt that the dentist and her staff were well trained, one patient said, “fantastic, I cannot fault them.”

The dentist had completed a patient survey in 2013, she had asked patients when they came into the surgery to completed the form, this asked questions such as waiting times, how staff treat people and the environment. The provider said 40 patients completed the survey after reviewing them; she saw most patients were happy with the surgery and the care they received.