We carried out this announced inspection on 3 October 2017 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 Care Quality Commission (CQC) inspector who was supported by a specialist dental adviser.

We told the NHS England area team that we were inspecting the practice. They did not provide any information.

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

Kindandental is in Newington Green, in the London borough of Islington. It provides NHS and private treatment to patients of all ages.

There is level access for people who use wheelchairs and pushchairs. Heavily restricted car parking spaces are available near the practice.

The dental team includes four dentists, four qualified dental nurses, two dental hygienists, and two receptionists, one of who is also a qualified dental nurse. There are two trainee dental nurses, a practice manager who is also a qualified dental nurse, and a practice administrator who is also a qualified dental nurse. The practice has four treatment rooms located on the ground and basement floors of a converted period building.

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 the inspection we collected feedback from 50 patients. This information gave us a positive view of the practice.

During the inspection we spoke with three dentists, three dental nurses, the receptionists, the practice administrators and the practice manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open at the following times:

Monday - Thurs: 8.30am – 5pm

Friday: 8am – 2.30pm

Saturday: Hygienist only 8am – 2pm

Our key findings were:

• The practice was clean and well maintained. They had infection control procedures which reflected published guidance.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• The practice 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 appointment system met patients’ needs.
• The practice asked staff and patients for feedback about the services they provided.
• The practice dealt with complaints positively and efficiently.
• Staff felt involved and supported and worked well as a team.
• The practice had systems to help them manage risk. Improvements could be made in ensuring identified risks were responded to promptly.
• The practice had systems to help them monitor and improve their service. Improvements could be made to ensure infection control audits were carried out more regularly, and to ensure learning points from the radiograph audit were documented and shared with all relevant staff.

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

• Review the fire and health and safety risk assessments to ensure all identified risks are monitored and mitigated and all actions are completed promptly.
• Review the practice's current audit protocols to ensure infection control audits are undertaken at regular intervals, and where applicable learning points from radiograph audits are documented and shared with all relevant staff.

Shortly after the inspection the practice took steps to begin to make improvements.

We gave 48 hour’s notice of our inspection to make sure we would be able to speak with the practice manager and the registered manager on the day.

We spoke with one person visiting the practice on the day and four people over the telephone who had recently used the practice.

All of the people we spoke with who used the practice told us that they’d had positive experiences of using the practice. One person told us that their experience had “been fantastic”. Another person said that the staff at the practice were always pleasant, patient and understanding.

People who used the practice felt informed about their treatment and care as well as the costs of treatment.

We found that recruitment practices were ad-hoc and that the provider did not have effective systems in place to make sure that some staff who worked with patients were suitable to carry out this work.

We found that people received care and treatment in a clean and hygienic environment and that staff followed guidance to make sure that effective infection prevention and control practices were maintained.

We found that the provider monitored the quality of its service, but their approach to obtaining feedback was inconsistent.