We carried out this announced inspection on 10 August 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 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

Birdgate Dental Practice is in the centre of Pickering and provides private dental treatment to adults and children.

There is level access for people who use wheelchairs and those with pushchairs. Car parking and public transport facilities are available near the practice.

The dental team includes two dentists, a treatment coordinator and oral health educator, three dental nurses, one dental hygiene therapist, practice manager and a receptionist. 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 collected 50 CQC comment cards filled in by patients.

During the inspection we spoke with one dentist, two dental nurses, the treatment coordinator and the practice manager. We looked at the practice’s policies and procedures and other records about how the service is managed.

The practice is open: Monday to Friday 9am-5pm

Our key findings were:

• The practice appeared clean and well maintained.
• The practice staff had infection control procedures which reflected published guidance.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• The practice had systems to help them manage risk. Not all the legionella recommendations had been carried out and fire safety systems needed review.
• The practice staff had suitable safeguarding processes and staff knew their responsibilities for safeguarding 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.
• The practice had effective leadership and a culture of continuous improvement.
• 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 staff dealt with complaints positively and efficiently.
• The practice staff had suitable information governance arrangements.

There were areas where the provider should make improvements.

• Review the practice's Legionella risk assessment and implement monthly water temperature testing the outlets.
• Review the practice's systems for checking and monitoring equipment taking into account relevant guidance and ensure that all equipment is well maintained in particular the confirmation of the safety of electrical fixed wiring and gas safety in the practice.
• Review the fire safety risk assessment and review the installation of emergency lighting. Ensure that any fire testing of the system is undertaken regularly and fire drills are in place.
• Review the storage of medicines requiring refrigeration to ensure they are stored in line with the manufacturer’s guidance and the fridge temperature is monitored and recorded.

Birdgate Dental Practice was a small practice with two dentists, one hygienist, three dental nurses and a practice manager. We were able to speak with one dentist, two dental nurses, the practice manager and one patient.

The patient told us that the dentist always discussed their treatment with them and told them the cost before proceeding with treatment. Other feedback we saw included "Clear advice is given prior to and during treatment" and "The hygienist is good and she explains what she is doing". The patient told us that they could always get an appointment if they needed one although they usually made their next appointment as they finished their current one. Feedback indicated that the service was relaxed and the staff were friendly and helpful.

The dental nurses said they worked together well as team and managed to discuss any issues that may have been raised during the working day. One of the nurses told us that they had regular supervision and they found this useful. They said that they felt they were supported by the dentist and the practice manager and were encouraged to access training they had identified as a part of their continued practice development.