We carried out this announced inspection on 23 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 Care Quality Commission (CQC) inspector who was supported by a specialist dental adviser.

We told the NHS England area team that we were inspecting the practice. They did not provide us with any information.

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

Belmont Dental Practice is located in Ilford, in the London Borough of Redbridge. The practice provides predominantly NHS and some private dental treatments to patients of all ages.

The practice is located on the ground floor of a purpose adapted premises. The practice has two treatment rooms. The practice is conveniently located close to public transport links.

The dental team includes the practice owner, a dentist clinical lead, three associate dentists who work part time, two qualified dental nurses and two trainee dental nurses.

The practice is owned by an individual who is the practice manager 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.

We received feedback from 33 patients via CQC comment cards and speaking with patients. This information gave us a positive view of the practice.

During the inspection we spoke the practice owner, the dentist clinical lead, one associate dentist and one dental nurse. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open between 9.30am and 1pm and between 2pm and 5.30pm on Mondays to Fridays.

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 assess and 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 had arrangements to deal with complaints positively and efficiently.

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

• 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.
• Review the practice’s protocols for recording in the patients’ dental care records or elsewhere the reason for taking the X-ray and quality of the X-ray ensuring compliance with the Ionising Radiation (Medical Exposure) Regulations (IRMER) 2000.
• Review the analysis of the grades for the quality of radiographs to ensure these are correctly recorded over each audit cycle and for each dentist.

We spoke with nine patients who all gave positive feedback about the care and treatment they had received. One patient told us “It is a very good service. They always explain everything to me.”

Patients told us that they were given a copy of the treatment and costs involved and given time to think before undergoing treatment.

We looked at ten clinical patient records which showed the dentist had recorded a gum health assessment and discussion of tobacco and alcohol use. This demonstrated to us a risk assessment process for oral disease.

We observed staff speaking to patients politely both at the practice and over the telephone and found they were happy to answer questions. We observed that records relating to patients were kept securely ensuring confidentiality.

The prevention and control of infection and decontamination of instruments was effectively carried out in accordance with guidance from the Department of Health. Patients we spoke with were very positive about the cleanliness of the practice telling us "It is very clean there. The dentist opens the instrument pouches in front of us so I know they are clean.”

We found that staff had support in their professional development and were encouraged to take part in additional training. The provider took account of complaints and comments to improve the service.