We carried out this announced inspection on 31 October 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

Pure Smiles – Fulham Road is Fulham in the London Borough of Hammersmith & Fulham. The practice provides NHS and private treatment to patients of all ages.

The practice is situated close to public transport bus and train services.

The dental team includes the two principal dentists who own the practice, one associate dentist, one dental hygienist and two dental nurses. The clinical team are supported by a receptionist and a treatment coordinator.

The practice is owned by a partnership and as a condition of registration must have a person registered with the Care Quality Commission as the registered manager. Registered managers 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 registered manager at Pure Smiles – Fulham Road was one of the principal dentists.

On the day of inspection we received feedback from 10 patients.

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

The practice is open:

Monday to Thursday from 9am to 7pm.

Friday from 9am to 5.30pm.

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. Improvements were needed to ensure that emergency medicines and equipment were available taking into account current guidance from the Resuscitation Council (UK).
• The practice had systems to help them manage risk. Improvements were needed so that the dentists used a rectangular collimator in accordance with taking into account Guidance Notes for Dental Practitioners on the Safe Use of X-ray Equipment
• 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.
• 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.

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

• Review availability of medicines and equipment to manage medical emergencies taking into account guidelines issued by the British National Formulary, the Resuscitation Council (UK), and the General Dental Council (GDC) standards for the dental team.
• Review the protocols and procedures for use of X-ray equipment taking into account Guidance Notes for Dental Practitioners on the Safe Use of X-ray Equipment. This relates specifically to the use of rectangular collimation.
• Review the practice’s arrangements for receiving and responding to patient safety alerts, recalls and rapid response reports issued from the Medicines and Healthcare products Regulatory Agency (MHRA) and through the Central Alerting System (CAS), as well as from other relevant bodies, such as Public Health England (PHE).
• Review the security of prescription pads in the practice and ensure there are systems in place to track and monitor their use.

• Review the practice’s protocols for referral of patients and ensure urgent referrals are monitored suitably.

People were very satisfied with their experience of using the service. They reported that staff were caring and easy to talk with. Comments made included "the dentist is really nice and looks after my teeth" "me and my sister were told how to look after our teeth". The dentists explained the consultation procedure, which treatment would be most effective and reasons why they thought so. They felt treated with dignity, respect and had received consultations and treatment in private.