We carried out an announced comprehensive inspection on 08 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

The practice is situated in the London Borough of Waltham Forest. The practice is laid out on the ground floor and includes four surgeries, a dedicated decontamination room, and a waiting room with reception area. Toilet facilities are not accessible to wheelchair users. There are plans to improve disabled access and facilities for staff as part of a planned refurbishment and extension of the premises in 2016.

The practice provides primarily NHS and some private dental services for adults and children. The practice offers a range of dental services including routine examinations and treatment, as well as some restorative and orthodontic treatment. The practice does not provide a sedation service. The principal dentist is registered with the GDC as a specialist in oral surgery. The practice is an approved vocational training practice and provides post qualification training for graduate dentists to enable them to join the NHS performers list in England and Wales.

There are five dentists working at the practice; three qualified and one trainee dental nurses; a hygienist; and one full time and one part time receptionist.

The practice is open between 9.00am 1.00pm and 2.00pm to 5.30pm Monday to Friday, and on Saturdays between 9.00am and 1.00pm by arrangement.

The principal dentist was the Registered Manager at the time of the inspection. A registered manager is a person who is registered with the CQC 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.

As part of our inspection we asked for CQC comment cards to be completed by patients prior to our inspection. We received 24 completed comment cards. We also spoke with four patients on the day of our visit. All the patient feedback we received was positive, for example about the standard of care received, the caring and friendly attitude of staff, and the ease of getting an appointment.

Our key findings were:

• There was a procedure for reporting incidents, and the practice learnt from incidents and complaints. However the dissemination of learning from incidents and resulting improvements to the service were not always formally documented.
• The practice had effective safeguarding processes in place and staff understood their responsibilities for safeguarding adults and children.
• There were systems in place to decontaminate equipment, and reduce and minimise the risk and spread of infection.
• There were systems in place to dispose of waste appropriately.
• Staff were trained in basic life support, and understood how to act in an emergency situation. The practice had emergency medicines, oxygen and an automated external defibrillator (AED).
• Dental care records were stored securely.
• Equipment, such as the autoclave (steriliser), fire extinguishers, and X-ray equipment had all been checked for effectiveness and had been regularly serviced.
• 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).
• Patients indicated that they felt they were informed about the treatment options available to them, and that they received good care.
• The practice received patient feedback through surveys and comments and complaints, and acted on it where possible to improve the service.
• The practice had carried out recent audits to review and improve the quality and safety of the services. However the dissemination of learning from audits and resulting improvements to the service were not always formally documented.
• The principal dentist had a clear vision for the practice and staff told us they were well supported by them.

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

• Review policy and procedures to ensure there is guidance for staff on handling notifiable safety incidents in accordance with the Duty of Candour.
• Review the practice’s protocols for the use of rubber dam for root canal treatment giving due regard to guidelines issued by the British Endodontic Society.
• Review the practice’s sharps procedures giving due regard to the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.
• Review the practice’s protocol for the sending of referral letters to ensure a consistent approach.
• Review the practice’s protocols for incidents, audits and complaints so that that the dissemination of learning and improvements are formally documented.
• Review its audit protocols to improve and maintain the quality of radiography.
• Review the frequency of practice meetings to involve staff better in the operation and development of the practice.