We carried out an announced comprehensive inspection on 31 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

Fartown Dental Practice – Huddersfield is situated in the Fartown area of Huddersfield, West 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 suite, one waiting area and a reception area. The reception area, waiting area and one surgery are on the ground floor. The other three surgeries are on the first floor. There are patient and staff toilet facilities on the first floor of the premises.

There are two dentists, three dental hygiene therapists, two qualified dental nurses, six trainee dental nurses and three receptionists. One of the qualified dental nurses also acts as the practice manager.

The opening hours are Monday to Friday from 8-00am to 6-00pm.

The practice owner 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 received feedback from 17 patients. The patients were generally positive about the care and treatment they received at the practice. Comments included that the staff were caring, respectful and professional. They also commented that the environment was clean, safe and hygienic and that they felt listened to.

Our key findings were:

• The practice appeared clean and hygienic.
• The practice had some systems in place to assess and manage risks to patients and staff including infection prevention, control and health and safety and the management of medical emergencies.
• The decontamination and sterilisation processes were effective.
• Staff had received training appropriate to their roles.
• Patients were involved in making decisions about their treatment and were given clear explanations about their proposed treatment including costs, benefits and risks.
• Oral health advice and treatment were provided in-line with the ‘Delivering Better Oral Health’ toolkit (DBOH).
• 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 regularly audited clinical and non-clinical areas of the service.

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

• Review the availability of buccal midazolam in the emergency drug kit.
• Review the availability of oropharyngeal airways in the emergency resuscitation kit.
• Review the local rules for the X-ray machines to ensure they are updated and include the names of the current practitioners.
• Review its complaint recording procedures to ensure that complaints are correctly logged and all documentation is kept.
• Review the process for undertaking the Infection Prevention Society audit to ensure it is completed every six months.

When we visited the practice in March 2014, we found the provider was not working in accordance with relevant infection control guidance. We also found that patient and staff records were not been stored and maintained effectively.

Following this inspection the provider wrote to us and told us they would take action to ensure they were compliant with these essential standards.

At this inspection we found improvements had been made. The necessary changes had been made to ensure the practice was clean and well maintained and all patient records were found to be suitably stored.

We spoke with two people who were patients at this practice. They told us they felt informed about their treatment. We looked at four electronic patient records and saw they contained information about the person's oral health needs and the treatment provided. We saw oral health risks were assessed in areas such as gum disease, mouth cancer and levels of tooth decay. We observed the receptionist asking people to check their medical history and sign copies of their treatment plans.

The practice was clean and hygienic. We saw evidence that equipment was sterilised to the appropriate standards.

We visited Fartown Dental Practice because we had received concerns about the treatment a patient had received. We spoke with four patients and 13 members of staff, including the Registered Provider (the Principal Dentist).

Patients said they felt involved in decisions about their care and treatment. They said the staff took time to explain their treatment options to them and they were given appropriate information and support regarding their care or treatment and where appropriate a written treatment plan.

Care and treatment was planned and delivered in a way that was intended to ensure patient’s safety and welfare. Before receiving treatment all patients were required to provide details of their past medical history, allergies and current medication.

Patients told us they were given a written treatment plan whenever their course of treatment extended over more than one appointment. They told us they were informed about any changes to their treatment and the costs.

The Provider had produced a Safeguarding policy to inform and advise staff of their responsibilities to protect children and vulnerable adults. However formal training in safeguarding procedures was lacking.

The standard of general cleaning in the practice was poor. There were no records to show that the staff, including the cleaning staff, had received appropriate training in maintaining appropriate standards of cleanliness in the practice.

There were a number of trainee staff employed at the practice. We were concerned that this placed a significant responsibility on the Provider, who was also responsible for the day to day running of the practice. However, staff told us they felt well supported and could seek advice or support at any time. They said that there was very good team working and the staff, “Get along really well”, “A really good team” and they “Can ask anyone for help.”

Staff records and other records relevant to the management of the services were not always adequate. The Provider did not have consistent arrangements for the completion, organisation and storage of information about staff employed at the practice. Patient records were not always kept securely.