We carried out this announced inspection on 22 June 2018 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 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

Dr Christine Hensley – Cheam Road is in the London Borough of Sutton and provides NHS and private treatment to adults and children.

There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces are available at the practice and also on surrounding roads.

The dental team includes two dentists, four dental nurses (who also provide reception duties), a dental hygienist, and a practice manager. The practice has two treatment rooms.

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 collected seven CQC comment cards filled in by patients and spoke with three other patients.

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

The practice is open: Monday and Tuesdays 8.40am to 6.00pm; Wednesday, Thursday and Fridays 9.00am to 6.00pm and Saturdays 9.00am to 1.00pm.

Our key findings were:

• The practice appeared clean and well maintained.
• The practice staff followed infection control procedures which reflected published guidance.
• Staff knew how to deal with emergencies. Most medicines were available for dealing with medical emergencies. Life-saving equipment were available.
• The practice had systems to help them manage risk. Although the fire safety systems required improvement.
• The practice staff 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.
• 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 and culture of continuous improvement.
• 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 staff dealt with complaints positively and efficiently.
• The practice staff had suitable information governance arrangements.

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

• Review the availability of medicines in the practice to manage medical emergencies taking into account the guidelines issued by the British National Formulary and the General Dental Council.
• Review the fire safety risk assessment and ensure that ongoing fire safety management is effective.

We spoke with five patients who all gave positive feedback about the care and treatment they had received. One patient told us "The staff are very friendly and helpful. There is a family atmosphere here which is welcoming."

Patients told us that they were given a copy of the treatment and costs involved and given time to think before undergoing treatment. We saw that the practice employed two dental hygienists. This demonstrated that patients had access to appropriate skilled staff to meet their care and treatment needs.

We observed staff speaking to patients politely both at the practice and over the telephone and found they were happy to answer questions. We observed that records relating to patients were kept securely ensuring confidentiality.

The prevention and control of infection and decontamination of instruments was effectively carried out in accordance with guidance from the Department of Health. Patients we spoke with were very positive about the cleanliness of the practice telling us.

We found that staff were supported in their professional development and encouraged to take part in additional training. However we had concerns there was not a formal system of appraisal to identify individual training needs. The provider had an effective system in place to regularly assess and monitor the quality of service that people receive. We found evidence that learning from incidents took place and appropriate changes were implemented.