We carried out an announced inspection of this practice on 4 February 2016. Breaches of legal requirements were found. After the inspection, the practice wrote to us to say what they would do to meet legal requirements in relation to safe care and treatment and clinical governance.

We undertook this follow up inspection to check they had followed their plan and to confirm they had now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Linden House Dental Practice on our website at www.cqc.org.uk

Our findings were:

Are services Safe?

We found that this practice was providing safe 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

Linden House dental practice is located near to the centre of Harrogate, North Yorkshire. They provide private dental care and treatment for adults and children receive treatment under the National Health Service (NHS). Parking is available locally. The practice also offers a dental care plan where patients pay a monthly subscription.

The practice currently has five dentists, two dental hygienists, five dental nurses, one receptionist and the registered provider is also the practice manager.

All four surgeries are located on the first floor of the building. There is also a reception and waiting area, a decontamination room, a dental panoramic radiography room/office and a staff room.

The practice is open:

Monday – Friday 08:40 – 17:30

The practice owner is registered with the Care Quality Commission (CQC) as an individual registered person. 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 implemented COSHH risk assessments for all dental materials used within the practice.
• All medicines and equipment used to manage medical emergencies are now in place giving due regard to guidelines issued by the British National Formulary and the Resuscitation Council (UK).
• All practice specific risk assessments have been completed.
• All audits including X-ray, dental care records and infection prevention and control have a documented action plan with guidance on improvements required and timescales for review.

We carried out an announced comprehensive inspection on 4 February 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 not 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

Linden House dental practice is located near to the centre of Harrogate, North Yorkshire. They provide private dental care and treatment for adults and children receive treatment under the National Health Service (NHS). Parking is available locally. The practice also offers a dental care plan where patients pay a monthly subscription.

The practice currently has five dentists, two dental hygienists, five dental nurses, one receptionist and the registered provider is also the practice manager.

All four surgeries are located on the first floor of the building. There is also a reception and waiting area, a decontamination room, a dental panoramic radiography room/office, and a staff room.

The practice is open:

Monday – Friday 08:40 – 17:30

On the day of inspection we received 34 CQC comment cards providing feedback and spoke with six patients The patients who provided feedback were positive about the care and treatment they received at the practice. They told us they were involved in all aspects of their care and were very pleased with the service. They found the staff to be kind, professional, friendly and the treatment to be first class. Also the staff had good communication skills, were efficient and caring and they were treated with dignity and respect in a clean and tidy environment. One patient did comment about better access to the practice opening times.

Our key findings were:

• Staff had been trained to manage medical emergencies.
• There were sufficient numbers of suitably qualified staff to meet the needs of patients.
• Infection prevention and control procedures were in accordance with the published guidelines.
• Patients’ care and treatment was planned and delivered in line with evidence based guidelines, best practice and current regulations.
• 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 practice sought feedback from staff and patients about the services they provided.

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

• Ensure availability and checks of all medicines and equipment used to manage medical emergencies are in place giving due regard to guidelines issued by the British National Formulary and the Resuscitation Council (UK)
• Implement COSHH risk assessments for all dental materials used within the practice.
• Ensure all practice specific risk assessments are implemented.
• Ensure all audits have a documented action plan with guidance on improvements required and timescales for review.

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:

• Store clinical waste securely.
• Review the process for checking all dental materials and equipment are in date.

• Review that the local rules are practice specific and are available for each piece of X-ray equipment giving due regard to the legal obligations under Ionising Radiation Regulations (IRR) 99 and Ionising Radiation (Medical Exposure) Regulation (IRMER) 2000.

• Review the protocol for receiving, sharing and acknowledging alerts by e-mail from the Medicines and Healthcare products Regulatory Agency (MHRA), the UK’s regulator of medicines, medical devices and blood components for transfusion, responsible for ensuring their safety, quality and effectiveness
• Review the complaints policy to make it more easily accessible to patients within the practice waiting room.
• Review the practice policies and procedures ensuring there are practice specific and in line with current guidelines.
• Update the 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.
• Implement a plan to review what the practice requires to meet best practice guidelines set out according to the Department of Health's guidance, Health Technical Memorandum 01-05 (HTM 01-05).

• Avoid storage of food in the same fridge where dental materials are stored are recorded daily.

To help us understand the experiences of people using the service, we spoke with people who had attended the surgery at the time of our inspection.

We spoke to three people in private at the practice address. Everyone we spoke to said that they were treated with respect. During our visit to the practice we saw that people’s privacy and confidentiality was maintained. People told us they had signed to say they agreed with the treatment and that they had their treatment options explained to them so that they could make an informed decision about dental care and treatment. Everyone we spoke with said they received good dental care and treatment. One person told us that “I am very happy with this practice particularly with (name of dentist). I was even able to get advice over the phone from them when I was away on holiday.”

The dental practice was clean and tidy and there were appropriate decontamination systems, policies and procedures in place. People told us that they had no concerns around the cleanliness of the practice. This helped to protect people’s health and wellbeing.

People told us that they felt that the staff at the practice were all very ‘competent’ in the work they did and that they felt safe and relaxed when receiving treatment.

People told us that they had not had any need to complain; but if necessary they would speak to either the dentist or dental nurse or the receptionist.