We carried out a focused inspection on 08 March 2017 at Surbiton Smile Centre.

We had undertaken an announced comprehensive inspection of this service on 25 November 2016 as part of our regulatory functions where breaches of legal requirements were found.

After the comprehensive inspection, the practice wrote to us to say what they would do to meet the legal requirements in relation to the breaches. This report only covers our findings in relation to those requirements and we reviewed the practice against one of the five questions we ask about services: is the service well-led?

We undertook this focused inspection on 08 March 2017 to check that they had followed their plan and to confirm that they now met legal requirements.

We found that this practice was now providing well-led care in accordance with the relevant regulations.

We carried out an announced comprehensive inspection on 25 November 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 not providing well-led care in accordance with the relevant regulations.

Background

The Surbiton Smile Centre is located in the London Borough of Kingston-upon-Thames. The premises are situated in a high-street location. There are two treatment rooms, a decontamination room with an area for X-rays, a reception room with waiting area, an office, and a patient toilet. These are situated on the ground floor of the building.

The practice provides 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 practice also offers specialist treatments such as implants, orthodontics and periodontics. The practice was in the process of making arrangements for carrying out conscious sedation at the time of the inspection.

The staff structure of the practice consists of a principal dentist, an orthodontist, an associate dentist, a dental nurse and a trainee dental nurse who also works as a receptionist.

The practice opening hours are Monday and Wednesday from 9.00am to 5.30pm, Tuesday from 8.00am to 4.30pm, Thursday from 9.00am to 7.30pm and Friday from 8.00am to 5.30pm. The practice is also open on alternate Saturdays from 8.30am to 3.00pm.

The principal 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.

The inspection took place over one day and was carried out by a CQC inspector and a dental specialist advisor.

Thirty-seven 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 not ensured that all staff maintained the necessary skills and competence to support the needs of patients. For example, staff were not up to date with training in managing emergencies, or safeguarding vulnerable adults and children, at the time of the inspection.

• There practice had some arrangements in place for managing medical emergencies.. However the practice did not have access to an automated external defibrillator (AED) on site. There was no written, risk assessment for accessing a nearby AED, which we were told was available at a local shopping outlet, at the time of the inspection.

• Equipment, such as the air compressor, autoclave (steriliser), and X-ray equipment had all been checked for effectiveness and had been regularly serviced. However, the fire extinguishers had not been serviced within the past year.
• Staff reported incidents and kept records of these which the practice used for shared learning.
• The practice had safeguarding processes in place and staff understood their responsibilities for safeguarding adults and children living in vulnerable circumstances.
• Patients indicated that they felt they were listened to and that they received good care from a helpful and caring practice team.

• 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.
• The practice had some governance arrangements and systems to monitor the quality and safety of the service. However, the practice had not effectively monitored and mitigated the risks associated with carrying out the regulated activities.

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

• Ensure staff training and availability of medicines and equipment to manage medical emergencies giving due regard to guidelines issued by the British National Formulary, the Resuscitation Council (UK), and the General Dental Council (GDC) standards for the dental team.
• Ensure staff are up to date with their mandatory training and their Continuing Professional Development.
• Ensure an effective system is established to assess, monitor and mitigate the various risks arising from undertaking of the regulated activities.
• Ensure systems are in place to assess, monitor and improve the quality of the service such as undertaking regular infection control audits and also ensuring that, where appropriate, audits have documented 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 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 practice’s safeguarding training; ensuring it covers both children and adults and all staff are trained to an appropriate level for their role and aware of their responsibilities.
• Review the practice’s infection prevention and control measures and ensure a Legionella risk assessment is undertaken and the required actions implemented taking into account 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 sharps procedures giving due regard to the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.

• Review the practice’s protocols for recording in the patients’ dental care records or elsewhere the reason for taking the X-ray and quality of the X-ray giving due regard to the Ionising Radiation (Medical Exposure) Regulations (IR(ME)R) 2000.

• Review the practice's protocols for completion of dental records giving due regard to guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.

• Review the practice's protocols for completion of dental records giving due regard to guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.

During our visit we spoke with the dentist and the dental nurse. We were unable to speak to anyone that used the service on the day of our visit so we contacted two people by telephone after the visit.

Both people we spoke with had become patients of the practice during the last year and both commented that they felt that the practice was very clean and tidy.

During our visit we saw a range of treatment consent forms and a number of records including treatment plans and consent forms signed by the person using the service. The people we spoke with confirmed that they had received detailed information, both verbally and in writing, regarding their proposed treatment and the costs.

A person who used the service we spoke with said "I can't find any fault with them".