Updated 15 March 2023
We carried out this announced comprehensive inspection on 28 February 2023 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 practice 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 advisor.
To get to the heart of patients’ experiences of care and treatment, we always ask the following 5 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:
- The dental clinic appeared clean and well-maintained.
- The practice had infection control procedures which reflected published guidance.
- Staff knew how to deal with medical emergencies. Appropriate medicines and most life-saving equipment were available. Equipment not available on the day, such as child size face masks and the self-inflating bag with reservoir (child) were ordered on the day of the inspection.
- The practice had some systems to manage risks for patients, staff, equipment and the premises. However, the electrical installation condition report was not available to view.
- Safeguarding processes were in place and staff knew their responsibilities for safeguarding vulnerable adults and children.
- The practice had staff recruitment procedures which reflected current legislation.
- Clinical staff provided patients’ care and treatment in line with current guidelines.
- Patients were treated with dignity and respect. Staff took care to protect patients’ privacy and personal information.
- Staff provided preventive care and supported patients to ensure better oral health.
- The appointment system worked efficiently to respond to patients’ needs.
The frequency of appointments was agreed between the dentist and the patient, giving due regard to National Institute of Health and Care Excellence (NICE) guidelines.
- Improvements could be made to the systems in place relating to the provision of oral sedation.
- There was effective leadership and a culture of continuous improvement.
- Staff felt involved, supported and worked as a team.
- Staff and patients were asked for feedback about the services provided.
- Complaints were dealt with positively and efficiently.
- The practice had information governance arrangements.
Background
The provider is part of a corporate group (Home Counties Clinics Ltd) and has 5 practices, and this report is about Agno Smile Ltd.
Agno Smile Ltd is in Rickmansworth and provides private dental care and treatment for adults and children.
There is step free access to the practice for people who use wheelchairs and those with pushchairs. Paid car parking spaces, including dedicated parking for disabled people, are available near the practice. The practice has made reasonable adjustments to support patients with access requirements.
The dental team includes the principal dentist, 7 associate dentists, 3 dental nurses, 2 dental hygienists, 1 orthodontic therapist, 1 group operations manager, 1 administrator and 2 receptionists. A dental sedationist visits the practice to provide intravenous conscious sedation. The practice has 4 treatment rooms.
During the inspection we spoke with 1 associate dentist, 2 dental nurses, 1 dental hygienist, 1 receptionist, the group operations manager and the administrator. We looked at practice policies, procedures and other records to assess how the service is managed.
The practice is open:
Monday from 9am to 7pm
Tuesday and Thursday from 10am to 6pm
Wednesday from 9am to 5pm
Friday from 8am to 4pm
Saturday (I per month) from 9am to 3pm
There were areas where the provider could make improvements. They should:
- Take action to ensure an effective system of checks and the availability of equipment in the practice to manage medical emergencies taking into account the guidelines issued by the Resuscitation Council (UK) and the General Dental Council.
- Improve the practice's protocols for medicines management and ensure all medicines are stored and dispensed of safely and securely.
- Implement protocols for oral conscious sedation and take action to ensure that all team members involved in the delivery of care and treatment to patients under sedation have the appropriate life support skills, taking into account the guidelines published by The Intercollegiate Advisory Committee for Sedation in Dentistry in the document 'Standards for Conscious Sedation in the Provision of Dental Care 2020’.
- Implement audits for prescribing of antibiotic medicines taking into account the guidance provided by the Faculty of General Dental Practice and take action to ensure audits of radiography and infection prevention and control are undertaken at regular intervals to improve the quality of the service.