We carried out this announced inspection on 6 November 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. They did not provide any information of concern.

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

Whitegates Dental Practice is in Doncaster and provides NHS and private treatment to adults and children.

There is level access for people who use wheelchairs and pushchairs. The practice has a dedicated car park including dedicated spaces for patients with disabled badges.

The dental team includes five dentists, eight dental nurses (two of whom are trainees), one receptionist and a practice manager. The practice has four 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 15 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, two dental nurses, the 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 to Thursday from 8:00am to 5:00pm

Friday from 8:00am to 4:00pm

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.

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

• Review the practice’s arrangements for gas and electrical safety testing.

We carried out an announced comprehensive inspection on 21 July 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 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

Whitegates Dental Surgery is situated in Doncaster, South Yorkshire. It offers mainly NHS treatment to patients of all ages but also offers private dental treatments. The services include preventative advice and treatment and routine restorative dental care.

The practice has four surgeries, a decontamination room, a waiting area and a reception area. All facilities are on the ground floor of the premises and there is wheelchair access through the side of the building.

There are four dentists, seven qualified dental nurses, a trainee dental nurse, two receptionists (one of whom is also a qualified dental nurse) and a practice manager (who is also a qualified dental nurse).

The opening hours are Monday from 8-00am to 5-30pm, Tuesday to Thursday from 8-00am to 5-00pm and Friday from 8-00am to 4-00pm.

One of the principal dentists is registered with the Care Quality Commission (CQC) as an individual. 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.

During the inspection we spoke with nine patients who used the service and reviewed four completed CQC comment cards. The patients were positive about the care and treatment they received at the practice. Comments included that the staff were helpful and friendly and that the service provided was excellent.

Our key findings were:

• The practice appeared clean and hygienic.
• The practice had systems in place to assess and manage risks to patients and staff including infection prevention and control and health and safety.
• Staff training was not actively monitored.
• Not all recruitment documents were available on the day of inspection.
• Oral health advice and treatment were provided in-line with the ‘Delivering Better Oral Health’ toolkit (DBOH).
• Patients were involved in making decisions about their treatment and were given clear explanations about their proposed treatment including costs, benefits and risks.
• We observed that patients were treated with kindness and respect by staff. Staff ensured there was sufficient time to explain fully the care and treatment they were providing in a way patients understood.
• Patients were able to make routine and emergency appointments when needed.
• The practice had a complaints system in place which was freely available to patients.

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

• Review staff awareness of what a significant event is.
• Review the current legionella risk assessment and implement the required actions including the monitoring and recording of water temperatures, giving due regard to the guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices, the HSE Approved Code of Practice and guidance on regulations L8 4th Edition 2013 and The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance.
• Review the protocol for completing accurate, complete and detailed records relating to employment of staff. This ensuring recruitment checks, including references, are suitably obtained and recorded.
• Review the protocols and procedures to ensure staff are up to date with their mandatory training and their Continuing Professional Development.

People who used the service told us that the practice was very welcoming. One person said, “The staff are very friendly.” People told us they were given options about their treatment. One person said, “The dentist discusses all my treatment with me and explains the benefits.” Another person said, “I am given time to reflect on my options.”

People who used the service told us that they did not have to wait long for an appointment. They felt that the practice would accommodate them if they needed to see a dentist in an emergency. People felt that staff put them at ease. One person said, “I used to have a fear of the dentists but I don’t anymore, they staff make me feel relaxed.”

People we spoke with said that the environment was always clean and tidy. Processes were in place to ensure that equipment was safe to use and clean. One person said, “The practice is always very clean, tidy and organised.”

We saw that staff had access to training and development. Staff enjoyed working at the practice and felt supported in fulfilling their role. They told us that they worked well as a team. People who used the service felt that the staff were competent in their roles.

The practice had a process in place to monitor people’s views about the service offered. The practice had a comments book and completed surveys. People we spoke with said that they had never needed to complain. One person said, “I have never had to complain, but I feel I could if I needed to.”