We carried out this announced inspection on 9 August 2018 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 principal dentist 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

Ryedale Dental Healthcare Clinic & Implant Centre Limited provides private treatment to adults and children.

There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces and public transport links are nearby.

The dental team includes one dentist, two dental nurses (one of whom is a trainee) and a receptionist. The practice has two treatment rooms.

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 58 CQC comment cards filled in by patients.

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 to Friday 9am-3pm

Our key findings were:

• The practice appeared clean and well maintained.
• The practice staff had infection control procedures which reflected published guidance.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available with the exception of an automatic defibrillator. A defibrillator was available near to the practice but a risk assessment had not been put into place.
• The practice could improve on their systems in managing risk in areas such as fire safety, safety alerts and sharps.
• The practice staff had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• The practice had staff recruitment procedures in place but staff recruitment records were not always complete.
• 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 practice was providing preventive care and supporting patients to ensure better oral health.
• The appointment system met patients’ needs.
• 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 staff dealt with complaints positively and efficiently.
• The practice staff had suitable information governance arrangements.

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

• Review the practice’s arrangements for receiving and responding to patient safety alerts, issued by the Medicines and Healthcare products Regulatory Agency, the Central Alerting System and other relevant bodies, such as Public Health England.
• Review the practice's recruitment policy and procedures to ensure accurate, complete and detailed records are maintained for all staff.
• Review the fire safety risk assessment review to ensure that any fire testing of the system is undertaken regularly.

• Review the availability of an automated external defibrillator, (AED), in the practice to manage medical emergencies, taking into account the guidelines issued by the Resuscitation Council (UK) and the General Dental Council, and undertake a risk assessment if a decision is made not to have an AED on site.
• Review the practice’s systems for assessing, monitoring and mitigating the various risks arising from the undertaking of the regulated activities. In particular the use of sharps.

We spoke with three patients of Ryedale Dental Healthcare Clinic and Implant Centre Ltd. People indicated that they were very happy with the treatment they had received. For example one patient told us "This dentist really understands her work and is good at explaining what my options are.” The practice consists of one dentist, a receptionist and a trainee dental nurse and we spoke with all of them. 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 effective risk assessment.

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

The practice had an effective system to regularly assess the quality of its service. For example, we saw there were regular audits of clinical practice and that the practice carried out patient surveys and responded effectively to comments.