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Inspection carried out on 1 May 2019

During a routine inspection

We carried out this announced inspection on 1 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 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

The Smiles Studio is in Chandlers Ford and provides NHS and private treatment to adults and children.

There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces, including those for blue badge holders, are available near the practice.

The dental team includes eight dentists, one oral surgeon, one lead dental nurse, five dental nurses, three trainee dental nurses, one dental hygienist, one practice manager, one business manager and three receptionists. The practice has four treatment rooms.

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 The Smiles Studio is the principal dentist. A registered manager is legally responsible for the delivery of services for which the practice is registered

On the day of inspection, we collected 40 CQC comment cards filled in by patients and spoke with two other patients.

During the inspection we spoke with four dentists, one lead dental nurse, one dental nurse, three trainee dental nurses, two receptionists, one business manager and the practice manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday to Friday 8.30am to 5pm

Saturday 8.30am to 1pm

Our key findings were:

  • The practice appeared clean and well maintained, however improvements could be made to the cleaning file with additional documentation.
  • The provider had infection control procedures which reflected published guidance, improvements could be made to workflows and conditions in the decontamination room.
  • Staff knew how to deal with emergencies. Appropriate medicines and most life-saving equipment were available, however some face masks were not available as recommended in guidance.
  • Improvements could be made by ensuring that staff fully understood ‘safer sharps’ and implemented guidance.
  • Improvements could be made by carrying out an antimicrobial prescribing audit, which would confirm guidelines were being followed and antibiotic stewardship understood by staff.
  • Improvements should be made to ensure that all actions from the legionella risk assessment had been completed.
  • The practice had systems to help them manage risk to patients and staff.
  • Improvements could be made by reviewing the use of rubber dams and ensuring staff use was in line with guidelines.
  • The provider had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
  • The provider 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, however improvements could be made by ensuring that treatment room view ports provided sufficient privacy to patients.
  • Staff were providing preventive care and supporting patients to ensure better oral health.
  • The appointment system took account of patients’ needs.
  • The provider had effective leadership and culture of continuous improvement. however improvements could be made to the auditing processes with independent verification.
  • Improvements could be made to Control of Substances Hazardous to Health (COSHH) Regulations 2002 file to ensure the safe storage and use of materials used.
  • Staff felt involved and supported and worked well as a team.
  • The provider asked staff and patients for feedback about the services they provided.
  • The provider dealt with complaints positively and efficiently.
  • The provider had suitable information governance arrangements, however improvements could be made to CCTV signage.

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

  • Review the practice's policy for the control and storage of substances hazardous to health identified by the Control of Substances Hazardous to Health Regulations 2002, to ensure risk assessments are undertaken and the products are stored securely.

  • Review the practice’s sharps procedures to ensure the practice is in compliance with the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.

  • 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.
  • Review the practice's Legionella risk assessment and implement any recommended actions, taking into account the guidelines issued by the Department of Health in the Health Technical Memorandum 01-05: Decontamination in primary care dental practices, and having regard to The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance.’