We carried out a follow up inspection on 15 November 2016 of Clifton Garden Dental Surgery.

We had undertaken an announced comprehensive inspection of this service on 8 March 2016 as part of our regulatory functions and during this inspection we found a breach of the legal requirements.

After the comprehensive inspection, the practice wrote to us to say what they would do 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 oneof 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 Clifton Garden Dental Surgery 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

Clifton Garden Dental Surgery is situated in Goole, Humberside. It offers mainly NHS treatment to patients of all ages but also offers private dental treatments. The services include preventative advice and treatment and routine restorative dental care. They also have a contract for the provision of minor oral surgery on a referral basis.

The practice has two surgeries, a decontamination room, one waiting area and a reception area. The reception area, waiting area and both surgeries are on the ground floor. The decontamination room is on the first floor. The toilet facilities were on the first floor of the premises.

The practice owner is registered with the Care Quality Commission (CQC) as an individual. Like registered providers, they are ‘registered persons’. 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 some issues relating to the health and safety of the premises. These included securing the external fire escape and ensuring the staff toilet was not used.
• The practice had not implemented a process to measure the water temperature to reduce the risk of Legionella developing. We were later sent evidence that this had been done.

We carried out an announced comprehensive inspection on 8 March 2016 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

Clifton Garden Dental Surgery is situated in Goole, Humberside. It offers mainly NHS treatment to patients of all ages but also offers private dental treatments. The services include preventative advice and treatment and routine restorative dental care. They also have a contract for the provision of minor oral surgery on a referral basis.

The practice has two surgeries, a decontamination room, one waiting area and a reception area. The reception area, waiting area and both surgeries are on the ground floor. The decontamination room is on the first floor. The toilet facilities were on the first floor of the premises.

There were two dentists, two dental nurses (one of which was on maternity leave) and a practice manager who also covered reception duties. The practice owner was also a qualified dental nurse and would assist when required.

The opening hours are Monday to Thursday from 9-00am to 5-30pm and Friday from 9-00am to 4-30pm.

The practice owner is registered with the Care Quality Commission (CQC) as an individual. Like registered providers, they are ‘registered persons’. 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.

During the inspection we received feedback from 46 patients. The patients were positive about the care and treatment they received at the practice. Comments included that the staff were respectful and courteous. They also commented that the environment was clean and hygienic and that they were listened to.

Our key findings were:

• The surgeries appeared clean and hygienic.
• The practice wase not recording water temperatures on a monthly basis or running infrequently used taps on a weekly basis following recommendations from their Legionella risk assessment.
• The dentists were qualified and staff had received training appropriate to their roles.
• Patients were involved in making decisions about their treatment and were given clear explanations about their proposed treatment including costs, benefits and risks.
• Oral health advice and treatment were provided in-line with the ‘Delivering Better Oral Health’ toolkit (DBOH).
• We observed that patients were treated with kindness and respect by staff. Staff ensured there was sufficient time to explain fully the care and treatment they were providing in a way patients understood.
• Patients were able to make routine and emergency appointments when needed.
• The practice had a complaints system in place and there was an openness and transparency in how these were dealt with.

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

• Ensure audit protocols to document learning points are shared with all relevant staff and ensure that the resulting improvements can be demonstrated as part of the audit process.
• Ensure an effective system is established to monitor and mitigate the various risks arising from undertaking of the regulated activities.

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

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

• Review the practice’s procedure for automatic control test giving due regard to guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices.
• Review the practice’s protocol for the frequency of checks on the emergency drugs.
• Review the availability of a handwashing sink in the staff toilet.
• Display only this practice’s sharps injury procedure display and ensure it contains local contact details for occupational health.
• Review the training, learning and development needs of individual staff members and have an effective process established for the on-going assessment and supervision of all staff.
• Review the storage of dental care records to ensure they are stored securely.
• Review the practice’s business continuity plan to include details of what the practice would do in the event of not being able to see patients.

On the day of our visit we spoke with people who attended the practice for dental treatment. They told us that they were consulted about the treatment they needed and, when appropriate, choices in treatment were explained and offered to them.

One person told us that they had attended the practice when they needed emergency treatment and that they were seen very quickly by a dentist. They were nervous as they had not visited a dentist for a long time. They said that the treatment they needed was explained to them very clearly and that this made them feel less nervous. They now visited the dentist regularly and had recommended the practice to their family and friends.

People told us that everyone who worked at the practice treated them with respect and that their privacy and dignity was promoted. They added that the receptionist, dental nurses and dentists went ‘over and above’ what they needed to do to make them feel welcome and comfortable at the practice.

We were told that the dentists at the practice were ‘excellent’. People said that they explained each procedure to them in detail and gave them choices about treatment when appropriate. One person said the dentist understood that they were nervous about receiving treatment and so took the time to explain things to them clearly and to make them feel comfortable about the treatment they were due to receive.

People told us that the dentist was very good at working with children. One person said that they had ‘two robust boys’ and all of the surgery staff were accepting of their behaviour and another said that their child was being introduced gradually to sitting in the dentist chair to have a check up.

When asked if the premises were clean, people told us they were ‘spotless’. People told us that they had always found all areas of the practice to be clean. They said that the dentist and dental nurse always wore personal protective equipment, such as disposable gloves and an eye shield, and that they were provided with a disposable apron and an eye shield.

We were only able to speak to one person who uses the service and they spoke positively about the care and treatment they had received. They expressed no concerns about the service or staff.

Regular surveys are conducted to obtain the views of people who use the service, we looked at a number of responses and feedback was very positive about information people received about their treatment, the attitude of staff and service provided. Examples of comments received were “I was put at ease straight away”, “the dentist explained the process”, “service was professional throughout”, “everyone was very polite and explained everything”.