We carried out an announced comprehensive inspection on 10 February 2017 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

Enhance Dental is a dental practice situated on the first floor of York House, a high street retail building, located in Garforth, nine miles from Leeds. The practice offers NHS and private treatments which include dental implants, orthodontics and cosmetic dentistry. Alternative access to care is available; the practice conduct weekly domiciliary home visit and visit local nursing homes. There are three treatment rooms; two of which are linked to a decontamination room. There is a patient consultation room, an X-ray room, a reception and patient waiting area. There is a staff office, staff facilities and two patient restrooms.

There are three dentists, one dental hygiene therapist, seven dental nurses (three of which have practice management responsibility and three dental nurses cover reception) and there is a practice cleaner. An implantologist and an orthodontist visit the practice one day/evening per week.The practice is located on the first floor and to assist patients with impaired mobility, access can be achieved via stair lift. Some free parking is available at the practice and two car parks within walking distance.

The practice is open between 8:45am – 5:00pm Monday to Friday, Saturday by appointment only. The Orthodontic clinic is Tuesday 5:30pm – 8:30pm.

The principal dentist is registered with the Care Quality Commission (CQC) as an individual registered person. 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 26 CQC comment cards providing feedback. Patients who provided feedback were very positive about the care and attention to treatment they received at the practice. Comments included that patients felt they were involved in all aspects of their care and found the staff to be very pleasant and helpful, the practice had a happy environment; staff were friendly and communicated well. 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:

• The practice had systems in place to assess and manage risks to patients and staff including infection prevention and control, health and safety and the management of medical emergencies.
• The practice was visibly clean and tidy.
• Staff had received safeguarding training, knew how to recognise signs of abuse and how to report it. They had 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.
• Infection control procedures were in accordance with the published guidelines.
• Oral health advice and treatment were provided in line with the ‘Delivering Better Oral Health’ toolkit (DBOH).
• Treatment was well planned and provided in line with current guidelines.
• 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 appointment system met patients’ needs.
• The practice was well-led and staff felt involved and supported and worked well as a team.
• The governance systems were effective and embedded.
• The practice sought feedback from staff and patients about the services they provided.

• There were clearly defined leadership roles within the practice.

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

• Review the medical emergency equipment requirements concerning access to a portable Automated External Defibrillator when conducting domiciliary visits.
• Review the process of using pre-stamped prescriptions when conducting domiciliary visits.
• Review the process of auditing X-rays ensuring they are clinician specific to bring in line with National Radiological Protection Board (NRPB) guidance.

We spoke with three people who used the service, two Dentists, and three members of staff. People who used the service were happy with the quality of care and dental treatment offered by the dental practice. Comments included:

“I’ve been coming here for since it opened. I’m very happy.”

“The staff are always lovely, chatty and friendly.”

“The dentist takes time to explain everything. You’re not pushed into any decisions.”

In the four patient records we looked at, we saw relevant information, such as medical and social history, had been recorded.

There were effective systems in place to reduce the risk and spread of infection. During our inspection we asked a member of staff to explain the decontamination process. We saw that there was a room dedicated to carrying out decontamination and that there was a clear dirty to clean route through the room.

The staff files demonstrated that members of staff had undergone continuous professional development as required by their professional body. This meant staff kept up to date with their clinical practice.

The provider had systems in place to identify, analyse and review risks and incidents. Information about quality and safety was gathered and monitored to identify risks and areas for improvement.