We carried out an announced comprehensive inspection on 9 June 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

Horn Hill Dental Surgery is situated in Millom, Cumbria. It offers a mixture of private and NHS dentistry in a ratio of 60% private and 40% NHS. The services include preventative advice and treatment, routine restorative dental care, minor oral surgery and conscious sedation.

The practice has three surgeries, a decontamination room, a sterilisation room, two waiting areas and a reception area. The reception area, one waiting area, the sterilisation room and one surgery are on the ground floor. The other two surgeries and the decontamination room are on the first floor. There are accessible toilet facilities on the ground floor of the premises.

There are three dentists (one of whom is on maternity leave), a dental hygienist, seven dental nurses, two receptionists, a practice manager and a cleaner.

The opening hours are Monday from 9-00am to 7-00pm, Tuesday and Wednesday from 9-00am to 5-30pm, Thursday from 9-00am to 7-00pm and Friday from 9-00am to 5-30pm.

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.

During the inspection we received feedback from 51 patients. The patients were positive about the care and treatment they received at the practice. Comments included that the premises were clean and pleasant, the staff were always polite and caring and that they received excellent care and service.

Our key findings were:

• The practice appeared clean and hygienic.
• The practice had systems in place to assess and manage risks to patients and staff including infection prevention, control and health and safety and the management of medical emergencies.
• Dental care records were detailed and showed that treatment was planned in line with current best practice guidelines.
• 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.
• Patients were involved in making decisions about their treatment and were given clear explanations about their proposed treatment including costs, benefits and risks.
• Patients were able to make routine and emergency appointments when needed.
• Staff from the practice visited local schools and children’s centres to provide oral hygiene advice.
• The practice was well-led and staff felt involved and supported and worked well as a team.
• The governance systems were effective.

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

• Review the staff’s safeguarding training ensuring all staff are trained to an appropriate level for their role and aware of their responsibilities.
• Review the availability of buccal midazolam in the emergency drug kits.

This report is only regarding the services provided at HMP Haverigg and it does not make any comment on the surgery and service being provided by the organisation in a nearby town.

The Horn Hill Dental Surgery was providing dental services in to HMP Haverigg on an outreach basis at the time of our visit. We found that there were issues with prisoners accessing the service in a timely manner. There was also a lack of information available for prisoners regarding what they could expect from dental services.

The environment was kept clean and hygienic and staff were following infection control procedures although there was a lack of resources and clarity about responsibility for cleaning some areas of the surgery.

The building supplied to dental services was not fit for purpose and was having a direct impact on the ability to provide an appropriate, timely and safe service.

There was a lack of quality assurance and monitoring systems in place. There was no system for responding to complaints or comments and there was no evidence of gathering or taking responsibility for any feedback from prisoners regarding the dental service provided.

We spoke with people who used the service and they told us they were very happy with the service they received:

"Everything is explained, staff talk me through my options".

"I am very happy with the service, staff are very friendly and efficient....I have no qualms at all".

"...in any one sitting the dentist explains things well".

We found that the practice respected people's right to consent to treatment and ensured that they were cared for safely and appropriately.

Staff told us that they felt supported and we saw that training and development opportunities were good.

The practice facilities were of a high standard and were clean and well maintained.