We carried out an announced comprehensive inspection on 26 October 2015 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

Crofton Park Dental Practice is located in the London Borough of Lewisham and provides both NHS and private dental services to patients. The demographics of the practice are diverse, serving patients from a range of social and ethnic backgrounds.

The practice is open Monday to Fridays generally from 8.30am to 5.00pm, with two evenings a week where they open until 7.00pm and on Saturdays from 9.00am to 1.00pm. The practice is set out over two levels and facilities include three consultation rooms (two on the ground floor and one on the first), reception and waiting area, decontamination room, staff room/ administration office. The premises are not wheelchair accessible however the practice has an agreement in place with local dental surgeries, and if required can refer to them patients who might have restricted mobility.

We spoke with patients on the day of the inspection and also received 11 completed Care Quality Commission comment cards. Patients were positive about the service and gave good feedback. They told us that staff were friendly and caring and described the dentists as gentle. Patients gave examples of how staff treated them with dignity and respect and made them feel comfortable. Information was given to them in formats easy for them to understand and staff explained things clearly so they understood their care and treatment.

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.

Our key findings were:

• Patients’ needs were assessed and care was planned in line with current guidance.
• Patients were involved in their care and treatment planning and felt able to make informed decisions.
• There were effective processes in place to reduce and minimise the risk and spread of infection.
• There were appropriate equipment and emergency drugs to enable the practice to respond to medical emergencies. Staff knew where equipment was stored.
• All clinical staff were up to date with their continuing professional development.
• There was appropriate equipment for staff to undertake their duties, and equipment was serviced and maintained appropriately.
• Staff had access to appropriate development opportunities.
• Appropriate governance arrangements were in place to facilitate the smooth running of the service, including a programme of audits for continuous improvements.

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

• Review availability of equipment to manage medical emergencies giving due regard to guidelines issued by the Resuscitation Council (UK), and the General Dental Council (GDC) standards for the dental team.

Our inspection on 22 February 2013 was a follow up inspection to check on the improvements made by the provider following our previous inspection on 4 January 2013, which had identified that people were not always fully protected from the risk of infection or from unsafe or unsuitable equipment.

At our inspection on 22 February 2013, we saw evidence that all staff had received training in local infection control and cross infection policies, and had read and signed to agree to follow these policies. A full infection control audit had been completed on 12 February 2013. Soiled or broken equipment had been removed and been replaced with appropriate and clean items, and personal protective clothing was provided for staff in all the areas we visited.

We also found there were suitable arrangements to ensure that people were protected from risks associated with unsafe equipment. The provider had systems in place to ensure that x-ray equipment was used only in accordance with appropriate technical specifications and guidance, and all items of electrical equipment used when treating patients had been safety tested on 25 January 2013.

As part of our inspection we spoke to four private patients. They told us that they were happy with the quality of services and treatments. They said that staff were professional, welcoming and flexible, appointments were available at convenient times for them, and that they felt they had received value for their money. One person told us, “It’s very difficult to find a dentist you feel happy with. Here the dentist takes time with patients and does not rush.”

Before our inspection we had received some information of concern, in particular relating to infection control protocols and practice.

At our inspection we saw that the provider had acted on the results of a recent external infection control audit and that there were processes in place to monitor some aspects of infection control. However, there was insufficient evidence that all staff had completed the provider’s infection control training, and not all aspects of staff compliance with hygiene and infection control procedures had been checked. In addition, we found some soiled items which presented a potential infection control risk.

There was no documented evidence that the provider had risk assessed the frequency of electrical safety testing on electrical items used for the treatment of patients. The formal policies, procedures and staff training in relation to x-ray equipment had not been kept up to date in accordance with the regulations governing use of the equipment.