We carried out this announced inspection on 4 April 2017 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

Dacre Banks Dental Practice is located in Harrogate and provides private treatments to adults and children. The services include preventative advice and treatment and routine restorative dental care. The dental practice is located in a shared building within the medical practice.

There is level access for people who use wheelchairs and pushchairs and a stair lift is also available to access the surgery as it is located on the first floor. Car parking spaces are available near the practice.

The dental team is comprised of one dentist and two dental nurses, one of which helps with the practice management. The practice has one treatment room.

The practice is owned by a company and as a condition of registration must have a person registered with the Care Quality Commission as the registered manager. Registered managers have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run. The registered manager at Dacre Banks Dental Practice is the principal dentist.

On the day of inspection we collected 47 CQC comment cards filled in by patients and spoke with two other patients. This information gave us a positive view of the practice.

During the inspection we spoke with the principal dentist and two dental nurses. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday 8.45am to 1.15pm

Tuesday, Thursday and Friday 8.45am to 3pm.

These hours relate only to bookable appointments and are extended at either end of the day for the treatment of emergency patients as required.

Our key findings were:

• The premises were clean, secure and well maintained but were a little cluttered due to space limitations.
• Infection control procedures were in place and we found improvements could be made to the validation process and ensure risk assessments and polices reflected the working process within the practice.
• Staff had been trained to handle emergencies; this was now overdue and had been booked recently.
• Appropriate medicines and life-saving equipment were available apart from buccal midazolam.
• The practice had systems to help them manage risk.
• The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children. No training had been completed by staff.
• The practice had staff recruitment procedures. Improvements were needed to the recruitment process to ensure all required information was held in respect of people employed at the practice
• 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 appointment system met patients’ needs.
• The practice had effective leadership. Staff felt involved and supported and worked well as a team.
• The practice had systems in place to respond to complaints positively and efficiently.

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

• Review the practice’s arrangements for receiving and responding to patient safety alerts, recalls and rapid response reports issued from the Medicines and Healthcare products Regulatory Agency (MHRA) and through the Central Alerting System (CAS), as well as from other relevant bodies such as, Public Health England (PHE).
• Review the practice's recruitment policy and procedures are suitable and the recruitment arrangements are in line with Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 to ensure necessary employment checks are in place for all staff and the required specified information in respect of persons employed by the practice is held.
• Review the immunisation status of all staff.
• Review staff safeguarding training, ensuring it covers both children and adults and all staff are trained to an appropriate level for their role and aware of their responsibilities.
• Review availability of medicines and staff training to manage medical emergencies giving due regard to guidelines issued by the Resuscitation Council (UK), and the General Dental Council (GDC) standards for the dental team.
• Review the practice’s infection control procedures, protocols and validation processes are suitable giving due regard to guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices and The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance’.
• Review the practice’s protocols for recording in the patients’ dental care records or elsewhere the reason for taking the X-ray and quality of the X-ray giving due regard to the Ionising Radiation (Medical Exposure) Regulations (IR(ME)R) 2000.
• Review the availability of an interpreter service for patients who do not speak English as their first language.
• Review dental care records to ensure they are completed appropriately giving due regard to guidance provided by the Faculty of General Dental Practice (FGDP) regarding clinical examinations and record keeping.
• Review the practice audit protocols, such as infection prevention and control to help improve the quality of service. The practice should also check all audits have documented learning points and the resulting improvements can be demonstrated.