Smiles Dental & Cosmetic Care

We carried out this announced inspection on 7 August 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 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

Smiles Dental & Cosmetic Care is in Headcorn and provides private treatment to adults and children.

There is no level access for people who use wheelchairs and those with pushchairs as the practice is on the first floor via a flight of stairs. Car parking spaces, including some for blue badge holders, are available near the practice.

The dental team includes one dentist, one dental nurse, the practice manager and one receptionist. The practice has one treatment room.

The practice is owned by an individual who is the principal dentist there. 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 22 CQC comment cards filled in by patients. We spoke with three other patients.

During the inspection we spoke with one dentist, one dental nurse, one receptionist and the practice manager. During our inspection process we asked to look at practice policies and procedures and other records about how the service is managed. There were only two policies available which were dated 2003.

The practice is open:

Monday, Tuesday and Thursday 9am to 5pm (the practice is closed for one hour on these days between 1pm to 2pm.)

Our key findings were:

• The practice appeared clean and well maintained.
• The provider had infection control procedures which reflected published guidance, but staff did not have up to date policies to refer to for infection control.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available, however, we noted that the medical oxygen had expired.
• The provider did not have any systems to help them manage risk to patients and staff.
• The provider did not have suitable safeguarding processes and not all staff knew their responsibilities for safeguarding vulnerable adults and children.
• The provider did not have 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.
• Staff provided preventive care and support patients to ensure better oral health.
• The appointment system took account of patients’ needs.
• The provider did not have effective leadership or a culture of continuous improvement.

• Staff felt involved and supported and worked well as a team.
• The provider asked staff and patients for feedback about the services they provided however they had not had any response to these requests.
• The provider told us how they would deal with complaints positively and efficiently, the practice had not received any complaints over the last four years.
• The provider did not have suitable information governance arrangements.

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

• Ensure patients are protected from abuse and improper treatment
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

Full details of the regulation/s the provider is not meeting are at the end of this report.

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

• Review the practice's protocols for completion of dental care records taking into account the guidance provided by the Faculty of General Dental Practice.
• Review the training, learning and development needs of individual staff members at appropriate intervals and ensure an effective process is established for the on-going assessment,
• Review the practice’s protocols for recording in the patients’ dental care records or elsewhere the reason for taking X-rays, a report on the findings and the quality of the image in compliance with Ionising Radiation (Medical Exposure) Regulations 2017 and taking into account the guidance for Dental Practitioners on the Safe Use of X-ray Equipment.
• Review the practice’s protocols for the use of rubber dam for root canal treatment taking into account guidelines issued by the British Endodontic Society.