Smilemaker Dental Practice

We carried out this announced inspection on 17 May 2019 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.

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 not 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

Smilemaker Dental Practice is in Orpington, in the London Borough of Bromley. The practice provides NHS and private treatment to adults and children.

There is no level step-free access for people who use wheelchairs or those with pushchairs. Car parking spaces are available on the premises.

The practice has two treatment rooms.

The dental team includes a practice manager (who also undertakes a dental nursing role), five dentists, two dental hygienists, two qualified dental nurses, and two receptionists.

The practice is owned by a company, and as a condition of registration must have a person registered with the CQC 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 practice is the principal dentist.

On the day of the inspection, we collected eight CQC comment cards filled in by patients.

During the inspection we spoke with the practice manager, the principal dentist, a dental nurse and a receptionist. We checked practice policies and procedures and other records about how the service is managed.

The practice is open at the following times:

Monday and Tuesday: 8:15am-5:45pm

Wednesday: 8:30am-5:30pm

Thursday: 8:15am-7:00pm

Friday: 8:00am-5:45pm

Saturday and Sunday: 10:00am-3:00pm

Our key findings were:

• The practice appeared clean.
• Staff felt supported and worked well as a team. They treated patients with respect and protected their privacy and personal information.
• The appointment system took account of patients’ needs.
• The provider had procedures to help them deal with complaints.
• Staff knew their responsibilities for safeguarding vulnerable adults and children.
• The clinical staff provided patients’ care and treatment in line with current guidelines. They were providing preventive care and supporting patients to ensure better oral health.

• The provider had not established thorough staff recruitment procedures.
• The provider had not implemented suitable systems for monitoring fire and electrical safety.
• The provider had not suitably assessed and mitigated risks. There was no sharps risk assessment. Risk assessments for hazardous chemicals were not fit for purpose.
• The provider had not undertaken a suitable Disability Access audit to continually assess how they could improve access for patients with enhanced needs.
• The provider’s infection prevention and control procedures did not reflect published guidance in some areas.
• The practice did not follow current national guidance regarding staff training when undertaking dental treatment using conscious sedation.
• The provider had not ensured that suitable policies were available to staff.

We identified regulations the provider was not complying with. They must:

• Ensure care and treatment is provided in a safe way to patients.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
• Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out the duties.
• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.

Full details of the regulations the provider was not meeting are at the end of this report.