We carried out an unannounced focused inspection on 19 April 2016 to follow up on previous inspections carried out on 23 and 29 September 2015 to ask the practice the following key questions; Are services safe, effective, 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 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

CQC inspected the practice on 23 and 29 September 2015 and asked the provider to make improvements regarding Regulation 12 HSCA (RA) Regulations 2014 Safe care and treatment, Regulation 15 HSCA (RA) Regulations 2014 Premises and equipment and Regulation 17 HSCA (RA) Regulations 2014 Good governance. We checked these breaches as part of the focused inspection on 19 April 2016.

Ismile Dental Practice provides private dental treatment and facial aesthetics from their practice in Tunbridge Wells, in Kent. The majority of the dental treatment provided is general dentistry. The practice mostly provides treatment for adults but has a very small number of patients that are children.

Practice staffing consisted of the principal dentist who is also the owner and registered manager, , one dental nurse, one receptionist and a practice 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.

The practice opening hours are 8.30am to 5.15pm Monday, Tuesday, Thursday and Friday and 8.30am to 7.00pm on Wednesday.

Our key findings were:

• The practice had systems and processes in place to assess risks to the health and safety of patients, staff and visitors.
• The practice had carried out audits in key areas, such as infection control, record keeping and the quality of X-rays.
• There were systems in place to check all equipment had been serviced and maintained regularly, including the steriliser and the X-ray equipment.
• Dental care records were consistent and contained accurate information of the treatments provided to patients.
• Staff followed the appropriate decontamination process of instruments according to national guidelines.
• There was a process in place to assess the risks in relation to the Control of Substances Hazardous to Health (COSHH) 2002 regulations.
• Staff had received further training appropriate to their roles and were supported in their continued professional development (CPD).

We carried out an announced comprehensive inspection on 23 September 2015 and 29 September 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 not providing safe care in accordance with the relevant regulations.

Are services effective?

We found that this practice was not 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 not providing responsive care in accordance with the relevant regulations.

Are services well-led?

We found that this practice was not providing well-led care in accordance with the relevant regulations.

iSmile Dental Practice provides general dentistry, such as treating tooth decay, gum disease and restorative dentistry. The practice provides private services for patients in Tunbridge Wells, Kent and the surrounding areas.

The practice staff includes one dentist, one person working as a hygienist / dental therapist / dental nurse as well as two receptionists. Dental services are provided Monday to Friday between the hours of 8.30am and 5.15pm.

The 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.

Twelve people provided feedback about the service. We looked at ten patient comment cards where all comments were positive about the service patients experienced at iSmile Dental Practice. Patients indicated that they felt the practice offered an excellent service and staff were professional, helpful and kind. They said that staff treated patients with dignity and respect. Patients had sufficient time during consultations with staff and felt listened to as well as safe.

Our key findings were:

• There were systems to check equipment had been serviced regularly, including the compressor, autoclave, oxygen cylinder and the X-ray equipment.
• Patients were provided with information and were involved in decision making about the care and treatment they received.
• The practice had a monitoring system to help ensure staff maintained their professional registration.
• There were meetings held in order to engage staff and involve them in the running of the practice.

We identified regulations that were not being met and the provider must:

• Ensure the content and quality of dental care records are in line with national guidance.
• Ensure that the practice is in compliance with its legal obligations under Ionising Radiation Regulations (IRR) 99 and Ionising Radiation (medical Exposure) Regulation (IRMER) 2000.
• Ensure the practice’s recruitment policy and procedures are suitable and the recruitment arrangements are in line with Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 to help ensure necessary employment checks are carried out for all staff and the required specified information in respect of persons employed by the practice is held.
• Ensure there is a system that monitors and records the hepatitis B status of clinical staff.
• Ensure systems are introduced for the proper and safe management of medicines.
• Ensure the practice has an effective system to assess, monitor and mitigate the risks arising from the undertaking of the regulated activities.
• Ensure that there are appropriate governance arrangements for the safe running of the service by establishing systems to monitor and assess the quality of the service.
• Ensure audits of various aspects of the service are undertaken at regular intervals to help improve the quality of the service. The practice should also ensure that all audits have doicumented learning points and the resulting improvements can be demonstrated.

You can see full details of the regulations not being met at the end of this report.

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

• Review the practice’s protocols for the use of rubber dams for root canal treatment, giving due regard to guidelines issued by the British Endodontic Society.