We carried out an announced comprehensive inspection on 19 May 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

Castle Dental Practice is a private dental practice which offers dental payment plans. The practice is located in the centre of Knaresborough, North Yorkshire with public car parking close by. The practice has five treatment rooms over two floors, a reception area, two waiting rooms, a decontamination room, a laboratory casting room, a children’s room and staff facilities.

Due to the surgeries being located on the first and second floors patients with mobility requirements are referred to a local practice which is more accessible.

There are four dentists, a dental hygiene therapist, two dental hygienists and five dental nurses (one of which also works as the practice administrator).

The practice is open:

Monday 08:30 - 19:00

Tuesday, Wednesday & Thursday 08:30 – 17:30

Friday 08:30 – 16:30.

One of the partners 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.

During the inspection we received feedback from 27 patients. The patients who provided feedback were very positive about the care and attention to treatment they received at the practice. They told us they were involved in all aspects of their care and found the staff to be a wonderful team who are excellent, pleasant and helpful. Patients commented they could access emergency care easily and they were treated with dignity and respect in a clean and tidy environment.

Our key findings were:

• Staff had received safeguarding training, knew how to recognise signs of abuse and how to report it. They had very good systems in place to work closely and share information with the local safeguarding team.
• There were sufficient numbers of suitably qualified staff to meet the needs of patients.
• Staff had been trained to manage medical emergencies.
• 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.
• There was a complaints system in place. Staff recorded complaints and cascaded learning to staff.
• The practice sought feedback from staff and patients about the services.

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

• Review and implement a Legionella risk assessment, giving due regard to guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices and The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance’ the HSE Legionnaires’ disease and the Approved Code of Practice and guidance on regulations L8.
• Review the practice protocol and ensure the practice implements a Fire risk assessment.
• Review the practice’s protocol for undertaking audits of X-rays and dental care records at regular intervals to help improve the quality of service. The practice should also ensure all audits have documented learning points so the resulting improvements can be demonstrated.
• Review the practice’s system for identifying and disposing of out-of-date stock.
• Review the practice's 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, in particular Disclosure Baring Service checks (DBS).
• Review the practice’s protocol for receiving, sharing and acknowledging alerts by email 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 practice’s protocols and procedures for promoting the maintenance of good oral health giving due regard to guidelines issued by the Department of Health publication ‘delivering better oral health: an evidence-based toolkit for prevention’.

In April 2013 we carried out an inspection of this service. We judged, at that time, that improvements were needed to ensure that people's consent to treatment was appropriately obtained and recorded. During our visit in June 2013 we found that improvements had been made and arrangements were in place for demonstrating that people's consent had been obtained.

During the April 2013 inspection we judged, at that time, that improvements were needed to ensure that patients who were treated in the ground floor surgery were treated in a clean and hygienic environment. During our visit in June 2013 we found that improvements had been made as the ground floor surgery was no longer used as a treatment area. We were told that alternative arrangements had been made for treating people who could not access the first and second floor surgeries.

We spoke with four patients on the day of our inspection. They told us that they felt fully involved in the decisions about their treatment and felt that whilst the dentist provided advice, the decision was always their own. Despite this, we found that documented evidence to show that consent had been obtained was not available. We have asked the provider to address this issue.

We asked patients about their experience of being a patient at Castle Dental. Comments from people included “All my family come here. They are extremely thorough and the level of service is very good”, “They are absolutely fantastic” and “I am very happy with this practice.”

Not all people were cared for in a suitable, clean and hygienic environment. We have asked the provider to address this issue.

The people we spoke with described the staff as "Brilliant", "Knowledgeable" and "Excellent." Appropriate checks were undertaken before staff began work. This meant the provider was assured that staff were not barred from working with adults or children.

The practice had in place a policy for managing complaints. People we spoke with told us that they had no concerns or complaints about the dental practice. People said they would speak with staff if they had any concerns.