We carried out an announced comprehensive inspection on 25 February 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

Dental Sense is located in the London Borough of Kingston-upon-Thames. The premises are situated on the ground floor of a building in a high-street location. There are three treatment rooms, a decontamination room, X-ray room, staff room, reception and waiting areas, and a patient toilet.

The practice provides private and NHS services to adults and children. The practice offers a range of dental services including routine examinations and treatment, veneers, crowns and bridges and implants.

The staff structure of the practice consists of a principal dentist, four associate dentists, three hygienists, a dental nurse, two trainee dental nurses and a practice manager.

The practice opening hours are on Monday from 9.00am to 5.00pm, Tuesday from 9.00am to 6.00pm, Wednesday from 9.00am to 5.00pm, Thursday from 9.00am to 7.00pm, Friday from 9.00am to 4.00pm and Saturday from 9.00am to 2.00pm.

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.

Twenty-five 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 systems in place to reduce and minimise the risk and spread of infection. However, further improvements could be made to ensure that the practice fully complied with guidance issued by the Department of Health.
• The practice had effective safeguarding processes in place and staff understood their responsibilities for safeguarding adults and children living in vulnerable circumstances. However, we did not see evidence that all staff had undergone relevant safeguarding training.
• Staff reported incidents and kept records of these which the practice used for shared learning.
• Equipment, such as the air compressor, autoclave (steriliser), fire extinguishers, and X-ray equipment had all been checked for effectiveness and had been regularly serviced. However, the ultrasonic bath had not had all of the recommended periodic checks. We also found that some items of equipment used in environmental cleaning were not stored safely.

• Patients indicated that they felt they were listened to and that they received good care from a helpful and caring practice team.

• 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.
• There were governance arrangements but the use of audits and risk assessments, as methods for driving improvements in the quality of the service, could be strengthened.

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 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.
• Review staff training to ensure that all of the staff had undergone relevant training, to an appropriate level, in the safeguarding of children and vulnerable adults.
• Review the practice's policy and the storage of products identified under Control of Substances Hazardous to Health (COSHH) 2002 Regulations to ensure a risk assessment is undertaken and the products are stored securely .
• Review the practice’s sharps procedures giving due regard to the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.
• Review recruitment procedures to ensure accurate, complete and detailed records are maintained for all staff.
• Review the storage of medicines requiring refrigeration to ensure they are stored in line with the manufacturer’s guidance and the fridge temperature is monitored and recorded.
• Review the use of risk assessments to monitor and mitigate the various risks arising from undertaking of the regulated activities.

People who use the service told us that they were satisfied with the treatment they had received and way it was provided. "I have been coming here for three years and have recommended the practice to others".

The procedure for consultation and treatment was fully explained including the fees charged. People were also told about any risks that might arise from treatments chosen.

People felt treated with dignity, respect and had received consultations and treatment in a way that maintained their privacy.

They did not comment on the infection control systems. They did tell us they thought the practice was kept clean, tidy and felt safe using the service.

They did not tell us about staffing numbers.

They were also aware of the complaints procedure and how to use it.

We saw there was enough information provided in different ways to enable people to understand the treatment being recommended, reason why it was needed and decide if they wanted it.

The records we saw were up to date, fully completed and showed people were receiving the treatment they required in a safe and hygienic environment.

A member of staff demonstrated the infection control and cross contamination systems followed that were in line with guidance.

There were enough staff on duty and on the rota to meet people's treatment and care needs.

There was a complaints policy and procedure that was accessible to people using the service and also a logging and investigation system.