We carried out this announced inspection on 6 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

Otley Road Dental Practice is in Harrogate, North Yorkshire and provides private treatment to adults and children.

There are five steps to access the premises making it difficult for people who use wheelchairs and pushchairs to access the service. The registered provider was aware of this and helped by installing hand rails both side of the stairs and would assist patients at their request. Car parking spaces are available at the practice.

The dental team includes the principal dentist, two dental nurses and a receptionist. The practice has one treatment room.

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 CQC 41 comment cards filled in by patients and spoke with five other patients. This information gave us a positive and caring view of the practice.

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

The practice is open:

Monday 9:30am - 8pm

Tuesday & Thursday 8am - 5pm

Wednesday 9:30am – 2:30pm

Friday 8am - 2pm

Our key findings were:

• The premises were clean, secure and well maintained but were a little cluttered due to space limitations.
• The practice had infection control procedures which reflected published guidance.
• Staff knew how to deal with emergencies. Not all appropriate medicines and life-saving equipment was available.
• The practice had systems to help them manage risk. Improvements could be made with regard to Legionella risk management.
• 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.

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

• Review the amount of equipment and materials on the surfaces in the surgery.
• Review the high priority actions are addressed in accordance with the practice Legionella risk assessment.
• Review the practice protocols for checking emergency drugs and equipment to ensure the recommended medical oxygen cylinder and drugs are available in the event of a medical emergency.
• 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 availability of an interpreter service for patients who do not speak English as their first language.
• Review and implement the need for polices and risk assessments for the provision of domiciliary care.

People were involved in the planning of their treatment and were given information to help them make an informed choice. Comments made by people who use the service included “everything is thoroughly explained” and “things are explained clearly and concisely and if there are any fees these are explained in advance”.

All the people we spoke to were very satisfied, saying that they had received appropriate care, treatment and support. Comments included “been coming a number of years - very happy”, “care is very good and they’re very patient” and “perfect - there’s never any problems”. Patients’ medical histories were updated regularly; with people asked at each attendance if there had been any changes in their health status.

Staff and the provider had attended safeguarding training and were aware of their roles and responsibilities in protecting people from abuse or the risk of abuse. The provider was in the process of obtaining police checks for his staff and implementing better recruitment procedures to help safeguard people. Staff were appropriately skilled and trained for their work.

The provider carried out appropriate auditing of the practice and sought patient feedback to ensure he provided a good service.