We carried out this announced inspection on 9 January 2019 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.

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

Chiswick Smiles is in the London Borough of Hounslow. The practice provides private treatment to patients of all ages.

The practice is situated close to public transport bus and train services.

The dental team includes the principal dentist who owns the practice, two specialist orthodontists, one specialist periodontist and a specialist prosthodontist who visit the practice, one dental hygienist and one dental nurse. The clinical team are supported by a practice manager.

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 received feedback from five patients.

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

The practice is open:

Mondays between 9am and 4.30pm

Tuesdays between 8.15 am and 6pm

Wednesdays between 9.30 am and 6.30pm

Thursdays between 8.30 am and 5pm

Fridays between 9am and 2.30pm

Saturdays between 9am and 3.30pm

Our key findings were:

• The practice appeared clean and well maintained.
• The practice had infection control procedures which reflected published guidance. Improvements were needed so that infection prevention and control audits were carried in line with current guidelines.
• Staff knew how to deal with emergencies. Improvements were needed to ensure that emergency medicines and equipment were available taking into account current guidance from the Resuscitation Council (UK). Some items were missing on the day of the inspection. These were ordered promptly.
• 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. Improvements were needed so dental care records were maintained consistently in accordance with the Faculty of General Dental Practice regarding clinical examinations and record keeping.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• The practice was providing preventive care and supporting patients to ensure better oral health.
• 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.
• The practice had suitable information governance arrangements.

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

• Review availability of medicines and equipment to manage medical emergencies taking into account guidelines issued by the British National Formulary, the Resuscitation Council (UK), and the General Dental Council (GDC) standards for the dental team.
• Review the practice’s infection control procedures and protocols to take into account guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices and have regard to The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance’. This relates specifically to carrying out infection prevention and control audits.
• Review the practice's protocols for completion of dental care records taking into account guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.
• Review the practice’s protocols for conscious sedation, taking into account guidelines published by The Intercollegiate Advisory Committee on Sedation in Dentistry in the document 'Standards for Conscious Sedation in the Provision of Dental Care 2015.

During our inspection we were not able to speak with anyone who uses the service. However, we looked at the systems the practice used to seek feedback from people and the systems in place that demonstrated people were involved in their treatment. The website for the surgery contained testimonials from people who use the service.

There were sufficient levels of staff who worked at the service and people could access specialist dentistry services at the practice.

The service provided relevant information to people about fee’s, treatments, and how they could make a complaint about the service.