We carried out this unannounced inspection on 25 May 2018 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We planned the inspection, in response to concerns received, 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?

During this inspection, we looked at the question “Is it safe?” and this formed the framework for the areas we looked 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.

Background

Goole Surgery is in East Riding of Yorkshire and provides NHS and private treatment to adults and children.

There is level access for people who use wheelchairs and those with pushchairs. Limited car parking spaces are available near the practice.

The dental team includes two principal dentists, three associate dentists, 11 dental nurses (four of whom are trainees), a dental hygienist, a dental therapist, a practice manager, two receptionists and three dental support workers. The practice has three treatment rooms. A sister practice is located in Howden and all staff work across both sites.

The practice is owned by a partnership 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 Goole Surgery was the practice manager.

During the inspection we spoke with two dentists, two dental nurses, a dental support worker, a receptionist and the practice manager.

We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday to Thursday 8am to 5pm

Friday 8am to 4pm.

Our key findings were:

• The practice appeared clean and well maintained.
• The practice had infection control procedures which mostly reflected published guidance.
• Staff knew how to deal with medical emergencies. Appropriate medicines and life-saving equipment were available.
• The provider had systems to help them manage risk.
• The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• The practice had suitable information governance arrangements.
• Staff felt involved and supported and worked well as a team.
• The practice manager’s policies and risk assessments were greatly detailed and this helped ensure practice procedures were maintained to support the running of the practice.

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

• Review the practice's recruitment procedures to ensure appropriate checks are completed prior to new staff commencing employment at the practice and accurate, complete and detailed records are maintained for all staff.
• Review the practice’s protocols for ensuring that all clinical staff have adequate immunity for vaccine preventable infectious diseases. The provider should consider the need to carry out a risk assessment for those members of staff whose immune status is unknown.
• Review the need to undertake a risk assessment for dental support workers to provide chairside support.
• Review the training, learning and development needs of individual staff members at appropriate intervals and ensure an effective process is established for the on-going assessment, supervision and appraisal of all staff.

We carried out an announced comprehensive inspection on 24 November 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 providing well-led care in accordance with the relevant regulations.

Background

Goole dental practice is located in the town centre of Goole and provides NHS and private treatment to patients of all ages. There are three treatment rooms (one of which is being refurbished), a decontamination room for sterilising dental instruments, a staff room/kitchen and a waiting room. There is also a sister practice located in Howden.

Access for wheelchair users or pushchairs is possible from two ground floor entrances, both which lead into the reception and waiting area. On street parking is available around the practice.

The dental team is comprised of five dentists, twelve dental nurses (two of which are trainees), two dental hygienist therapists, two receptionists and a practice manager. Staff work between the two practices.

The practice is open:

Monday, Tuesday, Thursday and Friday 8am – 5:30pm

Wednesday 8am -7pm.

The practice manager is the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. 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.

On the day of inspection we received 31 CQC comment cards providing feedback. The patients who provided feedback were very positive about the care and attention to treatment they received at the practice. They told us they were involved in all aspects of their care and found the staff to be very pleasant and helpful, friendly and communicated well. Patients commented they could access care easily and where applicable had help with mobility requirements with good support. Comments were made about easy access to emergency care and they were treated with dignity and respect in a clean and tidy environment.

Our key findings were:

• The practice had systems in place to assess and manage risks to patients and staff including infection prevention and control, health and safety and the management of medical emergencies.
• The practice was visibly clean and uncluttered.
• Staff had received safeguarding training, knew how to recognise signs of abuse and how to report it. They had very good systems in place to work closely and share information with the local safeguarding team.
• There were sufficient numbers of suitably qualified staff to meet the needs of patients.
• Infection control procedures were in accordance with the published guidelines.
• Oral health advice and treatment were provided in-line with the ‘Delivering Better Oral Health’ toolkit (DBOH).
• Treatment was well planned and provided in line with current best practice guidelines.
• Patients received clear explanations about their proposed treatment, costs, benefits and risks and were involved in making decisions about it.
• Patients were treated with dignity and respect and confidentiality was maintained.
• The appointment system met patients’ needs.
• The governance systems were not effective and embedded.
• The practice sought feedback from staff and patients about the services they provided.
• There were clearly defined leadership roles within the practice and staff felt supported at all levels.

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

• Review the practice COSHH risk assessments are implemented and reviewed including the practice sharps handling procedures and protocols are in compliance with the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013, the latex risk assessment and the use of an open flame in the dental surgery.
• Review the practice audits of various aspects of the service, such as radiography and cross infection and control are undertaken at regular intervals to help improve the quality of service. Practice must also ensure all audits have documented learning points and the resulting improvements can be demonstrated.
• Review that the practice has a robust process to record significant events.
• Implement a disability access audit.
• Review the checks and availability of oxygen and equipment is in place to manage medical emergencies giving due regard to the guidelines issued by , the Resuscitation Council UK – the body responsible for setting standards for cardiopulmonary resuscitation in the United Kingdom.
• 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 use of rectangular collimation for X-ray equipment in all surgeries.