We carried out an announced comprehensive inspection on 04 February 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

The Porchester Dental practice is located in the London Borough of Westminster. The premises are situated in a lower ground floor and basement of a building in a high-street location. There are two treatment rooms, a reception area, a decontamination area, a patient toilet and storage room across both floors. There is another dental practice co-located in the same premises; this practice shares all staff and governance structures.

The practice provides NHS and private services to adults and children. The practice offers a range of dental services including routine examinations and treatment, veneers and crowns and bridges.

The staff structure of the practice consists of a principal dentist and two trainee dental nurses. There is also another principal dentist working at the practice, who is registered as a separate individual with the Care Quality Commission (CQC).

The practice opening hours are from Monday to Friday from 9.00am to 5.00pm.

The principal dentist is registered with the CQC as an individual. 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 inspection took place over one day and was carried out by a CQC inspector and a dental specialist advisor.

Twenty-three people provided feedback about the service. Patients were positive about the care they received from the practice. They were complimentary about the friendly and caring attitude of the dental staff.

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).

• There were effective systems 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 children living in vulnerable circumstances.
• Staff knew how to report incidents and how to record details of these so that the practice could use this information for shared learning.
• Equipment, such as the air compressor, autoclave (steriliser), fire extinguishers, and X-ray equipment had all been checked for effectiveness and had been regularly serviced. However the practice had not carried out all of the regular checks recommended for the ultrasonic bath.
• Staff did not have access to an automated external defibrillator (AED) in line with current guidance and had not undertaken and documented a risk assessment as regards its absence.
• Patients indicated that they felt they were listened to and that they received good care from a helpful and caring practice team.
• The practice ensured staff maintained the necessary skills and competence to support the needs of patients.
• The practice had implemented clear procedures for managing comments, concerns or complaints.
• The provider had a clear vision for the practice and staff told us they were well supported by the management team.
• Governance arrangements were in place for the smooth running of the practice. Improvements could be made to the current system of audits to better monitor and enhance the quality of the service.

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

• Review the use of audits, such as those checking the quality of radiography and dental care records, to help monitor and improve the quality of service. The practice should also check that, where appropriate, audits have documented learning points and the resulting improvements can be demonstrated.

• Review the availability of 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 staff training to ensure that all staff, including the trainee dental nurses, have completed, and regularly update, training in relation to safeguarding vulnerable adults and children.
• Review the practice’s testing protocols for equipment used for cleaning used dental instruments giving due regard to 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’s recruitment protocols to ensure that, where appropriate, Disclosure and Barring Service (DBS) checks are completed prior to employment, or a risk-based assessment, and associated safeguards, are put in place during the period that these checks are being processed. Alternatively, the risk assessment should explicitly state why such a check is unnecessary.

It was not possible to speak with people who use the service as no appointments had been scheduled during the time of the inspection. We looked at ten feedback forms that had been completed during the past month. These indicated that people who use the service were satisfied with the treatment received and would recommend the clinic to a friend.