Vistara Smiles

We carried out this announced inspection on 7 June 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 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 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

Vistara Smiles is in Islington, London, and provides private treatment to patients of all ages.

There is level access for people who use wheelchairs and those with pushchairs.

The dental team includes three dentists (one of whom worked on a locum basis), and two trainee dental nurses (both of whom undertake receptionist duties). The practice has three treatment rooms.

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 obtained feedback from 18 patients.

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

The practice is open from Monday to Saturday by appointment.

Our key findings were:

• The practice appeared clean and well maintained.
• Staff knew how to deal with emergencies.
• Staff knew their responsibilities for safeguarding vulnerable adults and children.
• 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.
• 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 was a lack of sufficient equipment to manage medical emergencies.
• Some infection control procedures did not reflect published guidance.
• The practice had not established effective systems to help them manage risk.
• The practice had not established thorough staff recruitment procedures.
• There was a lack of effective processes to ensure all staff had received or updated key training.
• There was a lack of evidence of adequate immunity against vaccine preventable infectious diseases for a member of staff.
• There was a lack of evidence of safety checks of electrical equipment.
• There was a lack of effective systems and processes to ensure good governance.

Shortly after the inspection the practice sent us evidence demonstrating they had begun to take steps to make improvements. We will check improvements have been implemented, sustained and embedded when we carry out a follow-up inspection of the practice.

We identified regulations the provider was not meeting. They must:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

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

• Review the practice's protocols for completion of dental care records taking into account guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.
• Review the practice’s system for managing significant events with a view to ensuring all staff have a good understanding of these, and to ensure a policy is available to provide guidance for staff.
• Review the practice’s infection control procedures and protocols to take into account guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices and have regard to The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance’.