We carried out an announced comprehensive inspection on 06 October 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

Ecladent is located in the London Borough of Barnet and provides private dental treatment to both adults and children. The premises are on the ground and first floor and consist of two treatment rooms, a consultation room, a decontamination room and the reception areas. The practice is open Monday to Wednesday 8:00am – 5:00pm, Thursday 9:00am – 9:00pm, Friday 9:00am – 3:00pm and alternate Saturdays 9:30am – 3:00pm.

The staff consist of the principal dentist, two associate dentists, a dental nurse, a receptionist and a practice manager.

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.

We reviewed the practice patient satisfaction survey and spoke with a patient. Patients were positive about the service. They were complimentary about the friendly and caring attitude of the staff.

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

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).
• We found the dentists regularly assessed each patient’s gum health and took X-rays at appropriate intervals.
• Patients were involved in their care and treatment planning so they could make informed decisions.
• There were effective processes in place to reduce and minimise the risk and spread of infection.
• The practice had effective safeguarding processes in place and staff understood their responsibilities for safeguarding adults and child protection.
• Equipment, such as the autoclave (steriliser), fire extinguishers, and X-ray equipment had all been checked for effectiveness and had been regularly serviced.
• Patients were treated with dignity and respect and confidentiality was maintained.
• The practice had implemented clear procedures for managing comments, concerns or complaints.
• Patients indicated that they found the team to be efficient, professional, caring and reassuring.
• Patients had good access to appointments, including emergency appointments, which were available on the same day.
• Leadership structures were clear and there were processes in place for dissemination of information and feedback to staff.

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

• Review availability of medicines and 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 the current Legionella risk assessment and implement the required actions including the monitoring and recording of water temperatures, taking into account 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 the practice protocol and ensure staff are aware of their responsibilities as per the Duty of Candour under The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
• Review the protocols and procedures for use of X-ray equipment taking into account Guidance Notes on the Safe use of X-ray Equipment.
• Review the protocols and procedures to ensure staff are up to date with their mandatory training and their Continuing Professional Development.
• Review the practice’s audit protocols to ensure audits of various aspects of the service, such as radiography and dental care records are undertaken at regular intervals to help improve the quality of service. Practice should also check that where applicable audits have documented learning points and the resulting improvements can be demonstrated.

During our last inspection on the 29 April 2013 we found non-compliance. Suitable arrangements were not in place to respond to allegations of abuse. At this inspection we found records that showed that staff were booked on safeguarding vulnerable adults and child protection training. Patient safety and child protection policies and procedures had been tailored to the needs of the practice. Staff knew to report any allegations of abuse to the manager, the local authority and Police as necessary.

Patients told us that treatment was explained to them by dental staff in private, that they were given a choice of treatment, were able to express their views and were involved in making decisions about their care and treatment. One patient told us "the dentist gave me a plan with options and costs, I knew exactly what was involved."

We spoke with staff and saw records that showed care and treatment was planned and delivered in line with their individual treatment plan. Patients were recalled at intervals based on their individual needs. One patient said “this is a really good practice." All of the patients we spoke with said they would recommend the dentist.

Patient safety and child protection policies and procedures had not been tailored to the needs of the practice. Staff knew to report any allegations of abuse to the manager but not to the local authority and police as necessary. Some staff had not attended training.

The premises were clean and well maintained. One patient told us the practice was "very clean and it looks plush". The provider told us that the practice was new and audits were planned to monitor infection control guidelines as detailed in Department of Health Technical Memorandum 01-05 (HTM 01-05).

We saw that patients' personal records including medical records were stored securely and were kept up to date. Records were retained and stored in accordance with the Data Protection Act 1998.