We carried out a desk based follow up inspection on 7 April 2017 of Castlegate Dental Centre.

We had undertaken an announced comprehensive inspection of this service on 23 February 2017 as part of our regulatory functions and during this inspection we found one breach of the legal requirements.

During the follow up inspection the practice produced an action plan detailing what they had prepared to meet the legal requirements in relation to the breach. This report only covers our findings in relation to those requirements.

We checked whether they had followed their action plan to confirm that they now met the legal requirements.

We reviewed the practice against one of the five questions we ask about services: is the service well led?

A copy of the report from our last comprehensive inspection can be found by selecting the 'all reports' link for Castlegate Dental Centre on our website at www.cqc.org.uk.

Our findings were:

Are services well-led?

We found that this practice was providing well-led care in accordance with the relevant regulations.

Background

Castlegate Dental Centre is located in York town centre and provides private treatment to adults and children, which includes dental implants, intravenous sedation, oral surgery, restorative and cosmetic dentistry.

The practice is located on the first and second floor, access is via a set of stairs which has handrails. Wheelchair users and patients who find the stairs difficult are informed of access to the practice prior to an appointment. Car parking spaces are available in the town or a local park and ride service offers easy access.

The dental team is comprised of four dentists, four dental nurses, two dental hygienists, one dental hygiene therapist, one practice manager and two receptionists working within four treatment rooms.

The practice is open: Monday to Friday 8:30am – 5:00pm.

The principal dentist is registered with the Care Quality Commission (CQC) as an individual registered person. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the practice is run.

Our key findings were:

• The practice had addressed issues relating to having in place an effective quality assurance process for Cone Beam Computed Tomography (CBCT) imaging equipment.
• The practice had addressed issues relating to having a sharps management risk assessment in place to mitigate the associated risks.
• The practice had addressed issues relating to the availability of lifesaving equipment and replaced emergency medical items found to be expired.

People we spoke with said that they received information about their dental care and treatment to maintain their oral health. People said they discussed their treatment options and agreed to the treatment they received. One person said, “They explain everything. I consented to the treatment that I had.” This ensured people’s rights were protected.

People told us they were happy with the care and treatment they had received. They said they could get appointments with a dentist when they needed to. One person said. “I am treated as an individual. It is brilliant. The dentist always explains everything they are going to do.”

We saw that the dental practice was clean and tidy. One person said. “The surgery is spotless.” Another person said. “The cleanliness is superb. I have no issues with this.” We saw that there were appropriate decontamination systems, policies and procedures in place to help to protect people’s health and wellbeing.

People said they felt there were enough staff available in the surgery and at reception to meet their needs. Staff were seen to be professional. A person said. "The dentists have the help they need there are dental nurses there to assist them.”

We saw that the practices comments and complaints procedure was available to people in reception. People we spoke with said they were aware of this but had no cause to complain. A person said. “I would tell them if I were not happy. I have never had any cause to complain at all.”

We carried out an announced comprehensive inspection on 23 February 2017 to ask the practice the following key questions; Are services safe, effective, caring, responsive and well-led?

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

Castlegate Dental Centre is located in York town centre and provides private treatment to adults and children, which includes dental implants, intravenous sedation, oral surgery, restorative and cosmetic dentistry.

The practice is located on the first and second floor, access is via a set of stairs which has handrails. Wheelchair users and patients who find the stairs difficult are informed of access to the practice prior to an appointment. Car parking spaces are available in the town or a local park and ride service offers easy access.

The dental team is comprised of four dentists, four dental nurses, two dental hygienists, one dental hygiene therapist, one practice manager and two receptionists working within four treatment rooms.

On the day of inspection we received 39 CQC comment cards providing positive feedback.

The practice is open: Monday to Friday 8:30am – 5:00pm.

The principal dentist is registered with the Care Quality Commission (CQC) as an individual registered person. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the practice is run.

Our key findings were:

• The practice appeared clean and well maintained.
• Infection control procedures practice followed published guidance but validation of decontamination equipment required improvement.
• Not all appropriate life-saving equipment was available as set out in current guidelines.
• Staff were trained to respond to medical emergencies.
• There was no effective practice fire risk management process in place.
• There was no effective practice environmental cleaning process in place.
• A sharps management risk assessment was required to mitigate associated risks.
• Staff understood and received safeguarding training and knew how to recognise signs of abuse and how to report it.
• There were sufficient numbers of suitably qualified staff to meet the needs of patients.
• Safe recruitment of staff was in place.
• Treatment was well planned and provided in line with current guidelines.
• There was no effective quality assurance process for Cone Beam Computed Tomography (CBCT) imaging equipment in place.
• Patients were treated with dignity and respect and confidentiality was maintained.
• The appointment system met patients’ needs.
• The service was aware of the needs of the local population and took these into account in how the practice was run.
• Staff felt involved and supported and worked well as a team.
• The practice sought feedback from staff and patients about the services they provided.
• Complaints were responded to in an efficient and responsive manor.

We identified regulations that were not being met and the provider must:

• Ensure that the practice is in compliance with its legal obligations under Ionising Radiation Regulations (IRR) 99 and Ionising Radiation (Medical Exposure) Regulation (IRMER) 2000 and take into account HPA-CRCE-010 guidance on the Safe Use of Dental Cone Beam CT (Computed Tomography) Equipment.
• Ensure the practice is in compliance with its legal obligations under Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.
• Ensure the practice has availability of medicines and equipment to manage medical emergencies and take into account guidelines issued by the British National Formulary, the Resuscitation Council (UK), and the General Dental Council (GDC) standards for the dental team.

You can see full details of the regulation not being met at the end of this report.

There were areas where the provider could make improvements and should:

• Review the practice’s procedures for the examination of electrical appliances and equipment to ensure they are safe to use.
• Review the practices environmental cleaning policy and take into account the Department of Health guidance, namely 'Health Technical Memorandum 01-05 -Decontamination in primary care dental practices (HTM 01-05) paying particular attention to patched and carpeted treatment room flooring, damaged areas on the dental chair and aging cabinetry which is difficult to clean.
• Review the practice’s fire risk management systems.
• Review its audit protocols to ensure infection control audits are undertaken at regular intervals and where applicable the action plans are implemented.