We carried out this unannounced inspection on 10 September 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

There is level access (via a portable ramp), for people who use wheelchairs and those with pushchairs. Car parking and public transport facilities are available near the practice.

The dental team includes two dentists, a visiting orthodontist, two dental nurses (one of whom is a trainee) a practice manager and two receptionists. The practice has four treatment rooms.

The practice was undergoing major refurbishment works, including, improving general and disabled access, all treatment rooms, waiting areas and installing a fully equipped disabled toilet.

The practice is owned by a company 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 Red Lea Dental Practice is the practice manager.

During the inspection we spoke with one dentist, three dental nurses, a receptionist and the practice manager. We looked at the practice’s policies and procedures and other records about how the service is managed.

The practice is open: Monday to Friday 9am - 5pm.

Our key findings were:

• The practice appeared clean and well maintained.
• The provider 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 staff had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
• The provider had thorough staff recruitment procedures.
• 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.
• The provider had suitable information governance arrangements.

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

• Review staff training to manage medical emergencies taking into account the guidelines issued by the Resuscitation Council (UK) and the General Dental Council.
• Review the practice's protocols to ensure the security of clinical waste, taking into account the guidance issued in the Health Technical Memorandum 07-01: Safe management of healthcare waste.

We carried out an announced comprehensive inspection on 7 December 2015 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

Red Lea Dental Practice is situated in Easingwold, York and is part of an organisation. The practice offers mainly NHS treatment with an option for some private treatments. The services include preventative advice, routine dental care and NHS Orthodontics.

The practice has four surgeries, one on the ground floor and three on the first floor, a decontamination room, a reception area, a waiting room, and toilet facilities.

The practice has two dentists, one dental nurse, a trainee dental nurse and an area manager.

The practice is open:

Monday – Friday 09:00 – 17:00

One of the practice owners 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 one CQC comment card providing feedback and spoke with seven 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 they were treated with dignity and respect in a clean and tidy environment.

Our key findings were:

• There was a complaints system in place. Staff recorded complaints and cascaded learning to staff.
• Staff had received safeguarding training, knew how to recognise signs of abuse and how to report it.
• Staff had been trained to manage medical emergencies.
• Infection control procedures were in accordance with the published guidelines.
• Patient 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 practice sought feedback from staff and patients about the services they provided.
• Governance arrangements were in place for the smooth running of the practice; however the practice did not have a structured plan in place to audit quality and safety beyond the mandatory audits for infection control and radiography. The practice planned to establish a more detailed system for this.

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

• Carry out audits of various aspects of the service, such as radiography and dental care records at regular intervals to help improve the quality of service. The practice should also check all audits have documented learning points and the resulting improvements can be demonstrated.
• Review the legionella risk assessment and action plan. Implement daily and monthly water testing and ensure a member of staff has received adequate training to be the competent person.