We carried out an announced comprehensive inspection on 1 March 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

City Healthcare Dental Services provide specialist dental care from their facility within The Highlands Health Centre, Bransholme, Hull. The location has good public transport links and adequate onsite parking. The health centre is situated next to a school and in a residential area.

The practice has four treatment rooms all on the ground floor, a waiting area, a reception area, an X-ray room, an X-ray developing room, a sterilisation room and a decontamination room connected by a hatch and a store room.

There is a ramp and automatic doors to enter the practice to help anyone with mobility requirements. There is one consultant in paediatric dentistry, a specialist in paediatric dentistry, a dental hygiene therapist, a senior nurse, a deputy team leader, three dental nurses, a secretary, an administration assistant and a full team of support through the company structure.

The practice offers specialist dental treatments under the NHS for children, including preventative advice, restorative dental care, inhalation sedation and all children who require general anaesthetics are triaged here to ensure all treatment is appropriate before sending for the general anaesthetic appointment.

The practice is open:

Monday – Thursday 08.30-17.00

Friday 08.30-16.30

The organisation has a designated 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 17 CQC comment cards providing feedback. 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 wonderful, informative, polite, and helpful 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 governance systems were effective.
• The practice sought feedback from staff and patients about the services they provided.

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

• Review the practice’s audit protocol of various aspects of the service, such as infection prevention and control and dental care records at regular intervals to help improve the quality of service. Practice should also check all audits have documented learning points and the resulting improvements can be demonstrated.
• Review the practice’s procedure for the transporting of instruments between the decontamination room and the surgery suitable 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’.
• Review the practice’s protocol for the recording of fridge temperatures where dental materials are stored.
• Review the practice’s protocol for the validation of the ultrasonic bath and record this appropriately.
• Review the process for checking the emergency medicines and equipment to ensure this is done weekly and recorded.

We saw evidence of how the provider used patient surveys and feedback to inform improvements to the service. Feedback was mostly complimentary and we saw examples of compliments on feedback cards.

We saw that the practice had a system for gaining consent and that forms were consistently completed. People's medical history and requirements informed the planning of care and treatments duly recorded. Emergency drugs were appropriate and available, and we saw other examples of the practice following published guidance.

The premises were clean and there were systems to minimise the risk of infection. The surgery rooms had clinical hand wash sinks that were not to the prevailing standard but were adequate for use. We saw examples of refurbished surgeries owned by the provider and were assured that refurbishment included design to the prevailing clinical standards.

Staff received regular training and supervisory support. The provider had a system for quality assurance and monitoring and we saw evidence that this was used to inform management decisions and policy review.