We carried out this announced inspection on 3 August 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.

We told the NHS England area team and Healthwatch that we were inspecting the practice. We did not receive any information of concern from them.

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

Hunmanby Dental Practice is near Filey, North Yorkshire and provides NHS and private treatment to adults and children.

There is level access for people who use wheelchairs and pushchairs. Car parking spaces are available near the practice.

The dental team includes three dentists, four dental nurses, one dental hygienist, one dental hygiene therapist, a receptionist and a practice manager.

The practice has four surgeries two on each floor, a dedicated room for taking Orthopantomogram (OPG) X-rays, a decontamination room for sterilising dental instruments, a staff room/kitchen and a general office.

The practice is owned by an individual who is the principal dentist there. They 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 collected 25 CQC comment cards filled in by patients. This information gave us a positive view of the practice.

During the inspection we spoke with two dentists (one of whom was the principal), two dental nurses, 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 – Friday 8:30am – 5:30pm.

Our key findings were:

• The practice was clean and well maintained.
• The practice had infection control procedures which reflected published guidance.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• 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.
• The practice had thorough staff recruitment procedures.
• 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 asked staff and patients for feedback about the services they provided.
• The practice dealt with complaints positively and efficiently.

We identified the practice had visible leadership within the practice and staff felt empowered and were confident in their roles which had a positive impact on staff, patients and the local community. This also demonstrated a commitment to tackling oral health inequalities, tackling inequity and promoting equality :

• Nervous patients said staff were compassionate and understanding. The practice was in the process of putting a 360 video about the practice on the website so patients could have a virtual tour of the practice before coming in. Audio files were available for patients with sight impairment. These included the practice leaflet and the principal dentist was happy to make a recording of any leaflet if required. We were shown different chairs had been implemented in the waiting room for patients including a chair at the same level as a wheelchair.
• We were told the staff worked proactively within the community and the principal dentist regularly attended parent toddler groups and preschool children sessions to discuss oral health, diet and prevention for parent and child. They had found this really useful to answer questions and myths about dental treatments. The practice held open days in the school holiday and had stations around the practice so children could choose what event they wished to be involved with one being a ‘selfie’ station to take big smiles pictures. The team also worked with a local charity which supported a local hospice the staff helped them by having open days or taking part in events.
• The practice used a detailed risk analysis template within the patient dental care records to assess patients’ individual needs and provided each patient with a specific risk assessment to show areas of improvement required. This had become an integral part of each examination as patients found they responded to all the information given and it also gave the team more information about patient’s needs, including aesthetic dentistry, tooth wear and oral cancer risk factors. This template was above the recommendations in guidance.

We believe this to be notable practice which is worth sharing.

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

• Review the practice’s protocols for domiciliary visits taking into account the 2009 guidelines published by British Society for Disability and Oral Health in the document “Guidelines for the Delivery of a Domiciliary Oral Healthcare Service”.
• Review the practice’s audit protocols to ensure, that where appropriate audits have documented learning points and the resulting improvements can be demonstrated.

We spoke with three patients of Hunmanby Dental Practice. We also saw a number of written comments from patients who had responded to a customer satisfaction survey. Over thirty patients had responded and we were able to see their suggestions for improvements and their comments about what they liked about the service. Patients indicated that they were satisfied with the service overall. For example one patient told us "They always explain the treatments available and give you time to make a decision.”

We spoke with the provider, an associate dentist and two dental nurses. They confirmed that their priority was to give a high quality service, to listen to their patients and to continually improve.

Patients told us that they were given appropriate information and advice so that they could make an informed decision about their treatment.

We saw patient records which showed that each person had a comprehensive assessment of their dental health needs and a plan of treatment. Each patient had been asked their consent to treatment and had signed their agreement.

We saw that patients were protected from harm, through the safe recruitment of staff, staff training and assessment of risk.

The practice was clean and hygienic and we saw there were robust infection control procedures in place to ensure patients were protected from the risk of infection.

The service handled complaints appropriately.