We carried out this announced inspection on 2 May 2018 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 CQC inspector who was supported by a specialist dental adviser.

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

Prestige Smiles is in the London Borough of Enfield and provides private treatment to adults and children.

The dental team includes a principal dental technician, two dentists and one dental nurse/practice manager

The practice is owned by an individual who is the principal dental technician. 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 inspection we collected 11 CQC comment cards filled in by patients.

During the inspection we spoke with one of the dentists and the dental nurse/practice manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

• Monday and Wednesday 9.30am to 4.00pm
• Thursday and Saturday 9.30am to 1.00pm

Our key findings were:

• The practice appeared clean and well maintained.
• The practice 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 systems to help them manage risk.
• 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 practice was providing preventive care and supporting patients to ensure better oral health.
• The appointment system met patients’ needs.
• The practice had effective leadership and a culture of continuous improvement.
• Staff felt involved and supported and worked well as a team.
• The practice asked staff and patients for feedback about the services they provided.
• The practice dealt with complaints positively and efficiently.
• The practice had suitable information governance arrangements.

During our last inspection, we identified that the infection control practices in the clinic were not effective due to the way instruments were dried after being sterilised and the lack of required infection control audits. We also found that recruitment procedures were not robust as references were not routinely sought for new staff. Furthermore, there were insufficient formal systems in place to regularly assess and monitor the quality of the service.

At this inspection, we found that the provider had made improvements. There were no patients in the clinic at the time of our inspection. The lead nurse had carried out detailed audits of infection control, recording keeping and antibiotic prescribing and s/he demonstrated to us how changes had been made to improve practice. No new staff had been recruited since the last inspection. However, the provider had updated their policy which detailed that references from previous employers would be routinely sought. Satisfaction surveys had been undertaken and analysed, and related feedback was discussed in a staff meeting to implement changes required.

On the day of our inspection there were no patients awaiting treatment. Two dentists worked at the practice on two alternate days per week, supported by nursing staff. The registered manager provided specialist denture treatment. We spoke with one patient and reviewed the suggestions box and responses contained in satisfaction surveys. A patient said, "I have been informed throughout about what is going on and I don't feel under any pressure." They also told us "I can't fault the treatment here."

People were provided with information about their treatment and were involved in their treatment plans. Treatment plans contained detailed and contemporaneous information. Staff were well equipped to manage emergency situations.

We identified concerns regarding the drying of sterilised equipment and the lack of required infection control audits. Recruitment procedures did not address requirements of the Care Quality Commission's regulations and we found that references were not routinely sought for new staff. We also identified that the provider had insufficient formal systems in place to regularly assess and monitor the quality of the service.