We carried out an announced comprehensive inspection on 20 September 2016 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

Dr. Perminder Chaggar’s Dental Practice is located in the London Borough of Richmond-upon-Thames. The premises are situated on the ground floor of converted residential building in a high-street location. There is one treatment room, a decontamination room, a reception and waiting area, a patient toilet, and a staff office.

The practice provides private services to adults and children. The practice offers a range of dental services including routine examinations and treatment, veneers and crowns and bridges. The practice also offers intravenous conscious sedation for some treatments.

The staff structure of the practice consists of a principal dentist, a dental nurse, a trainee dental nurse, and a receptionist.

The practice opening hours are Monday to Wednesday from 8.30am to 5.00pm.

The principal dentist is registered with the Care Quality Commission (CQC) as an individual. 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.

The inspection took place over one day and was carried out by a CQC inspector and a dental specialist advisor.

Twelve people provided feedback about the service. Patients were positive about the care they received from the practice. They were complimentary about the friendly and caring attitude of the dental staff.

Our key findings were:

• Patients’ needs were assessed and care was planned in line with current guidance such as from the National Institute for Health and Care Excellence (NICE).

• There were effective systems in place to reduce and minimise the risk and spread of infection. However, some improvements to the infection control processes were identified on the day of the inspection; these were promptly resolved by the provider.
• The practice had effective safeguarding processes in place and staff understood their responsibilities for safeguarding adults and children living in vulnerable circumstances.
• Staff reported incidents and kept records of these which the practice used for shared learning.
• There were effective arrangements in place for managing medical emergencies.
• Equipment, such as the autoclave (steriliser), fire extinguishers, and X-ray equipment had all been checked for effectiveness and had been regularly serviced. However, the ultrasonic bath and air compressor had not been serviced at the time of the inspection. The provider sent evidence after the inspection to confirm that these items had been serviced.
• Patients indicated that they felt they were listened to and that they received good care from a helpful and caring practice team.
• The practice ensured staff maintained the necessary skills and competence to support the needs of patients. However, there were some areas where the need for additional staff training was identified during the course of the inspection. The provider subsequently confirmed that the relevant training courses had been booked.
• The practice had implemented clear procedures for managing comments, concerns or complaints.
• The provider had a clear vision for the practice and staff told us they were well supported by the management team.
• Governance arrangements and audits were effective in improving the quality and safety of the services. However, there were some areas where governance arrangements could be strengthened through the use of additional risk assessments or audits. The provider assured us that these systems would now be implemented.

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

• Review the practice’s infection control procedures and protocols giving due regard to guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices and The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance.
• Review it’s responsibilities as regards to the Control of Substances Hazardous to Health (COSHH) Regulations 2002 and, ensure all documentation is up to date and staff understand how to minimise risks associated with the use of and handling of these substances.
• Review the practice's recruitment policy and procedures to ensure character references for new staff as well as proof of identification and records of qualifications are requested and recorded suitably.
• Review the protocols and procedures to ensure staff are up to date with their mandatory training and their Continuing Professional Development.

People we spoke with told us: "I am very happy with the way they treat me. I have been using this practice for years". We saw that people were provided with sufficient information about the treatments available and their cost. The treatment information also included any risks attached to them. The dentist told us that it was part of the whole philosophy of care that people were only provided with treatment that would benefit them.

People we spoke with told us they were very happy with the care, support and treatment they received. They said, "I feel confident and cared for". The records we saw showed us the practice delivered care and treatment that reflected the agreed treatment plans and included consent.

There were effective systems in place to reduce the risk and spread of infection. During our visit we saw that all areas of the practice were clean and well maintained. We found that the provider was engaged in continuous professional development through study events and other forms of learning. We saw that regular opportunities were provided to the dental nurse to continue their professional development and certificates and other evidence of learning were available at the practice.

Feedback and comments from people were sought by questionnaires and comment sheets. The practice also had a clear complaints procedure which emphasised the importance of people's views to the practice.