We carried out this announced inspection on 26 October 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 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

Cranham Dental Centre is located in Upminster, in the London Borough of Havering. The practice provides NHS and private dental treatments to patients of all ages.

The practice is located on the ground and first floor of a purpose adapted residential premises. The practice has four treatment rooms, three of which are located on the ground floor treatment rooms. The practice is conveniently located close to public transport links.

The dental team includes the principal dentist and five associate dentists, two dental hygienists, three qualified dental nurses, one trainee dental nurse and two receptionists.

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 Cranham Dental Centre was the principal dentist.

We received feedback from 39 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 principal dentist, one associate dentist, one qualified dental nurse, the trainee dental nurse and both receptionists. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open between 9am and 5pm on Mondays to Fridays and between 8.30am and 1pm on Saturdays.

The practice is closed between 1pm and 2pm for lunch.

Our key findings were:

• The practice was clean and well maintained.
• The practice had infection control procedures which reflected published guidance. However infection control audits were not carried out regularly in line with current 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. However staff had not completed training in safeguarding children and adults at risk.
• 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 dealt 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 protocols for infection prevention and control so that infection control audits are carried out in line with current guidance.
• Review the practice protocols in relation to the Control of Substances Hazardous to Health COSHH so that risks are assessed and relevant information is available for staff.
• Review staff training to ensure that all of the staff undertake relevant training, to an appropriate level, in infection control and the safeguarding of children and adults at risk.
• Review the training, learning and development needs of individual staff members at appropriate intervals and ensure an effective process is established for the on-going assessment, supervision and appraisal of all staff.

People felt they were respected and treated well. Treatments were explained clearly and that they were able to ask questions to clarify anything that was not clear. People felt that the premises were very clean and were well maintained.

People we spoke with told us that they felt they were respected and treated well. They said possible treatments were explained clearly and that they were able to ask questions to clarify anything that was not clear. They said there was a good system for booking appointments and they were given choice over appointment times to suit their convenience.

People told us that all staff, including dental staff were friendly and polite towards them. They also told us they did not have to wait long, either for an appointment when booking, or to be seen by a dentist on the day of the appointment.