We carried out this announced inspection on 7 November 2018 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.

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

Fresh Dental Smile Clinic is in Rawcliffe, York and provides private treatment to adults and children. Treatments include conscious sedation and dental implants.

There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces are available near the practice.

The dental team includes six dentists, two trainee dental nurses and four receptionists. The practice has three 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 eight CQC comment cards filled in by patients.

During the inspection we spoke with two dentists, one dental nurse and two receptionists. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday to Friday from 9:30am to 5:00pm

Our key findings were:

• The practice appeared clean and well maintained.
• The provider 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 to patients and staff.
• The practice staff had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
• The provider had staff recruitment procedures. Improvements could be made to the process for obtaining DBS checks for new members of staff.
• 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 provider was providing preventive care and supporting patients to ensure better oral health.
• The appointment system met patients’ needs.
• The practice had effective leadership and culture of continuous improvement.
• 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 provider dealt with complaints positively and efficiently.
• The provider had suitable information governance arrangements.

There were areas where the provider could make improvements. They should:

• Review the practice's recruitment procedures to ensure that appropriate checks are completed prior to new staff commencing employment at the practice.
• Review the practice's Legionella risk assessment and ensure monthly water temperatures are taken at the sentinel outlets.

We carried out an announced inspection on 28 September 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.

We found a number of shortfalls in meeting the fundamental standards and sent a letter to the provider requiring them to take urgent action to address the issues raised.

We subsequently revisited the practice on 10 November 2017 to ensure the issues we had identified in the original inspection had been rectified. This report combines our findings from both visits, describing the original shortfalls and the rapid action taken to correct these.

Both inspections were led by a CQC inspector who was supported by a specialist dental adviser.

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

Fresh Dental Smile Clinic is in Rawcliffe, York and provides private treatment to adults and children. Treatments include conscious sedation and dental implants.

There is a small step to access the practice. Car parking spaces are available near the practice.

The dental team includes four dentists (of which there is a principal who provides sedation and dental implants, an associate dentist, a visiting periodontist and a visiting endodontist), two dental nurses (one of which is a trainee), a dental hygienist and two receptionists.

The practice has three surgeries, one on the ground floor, two on the first floor. A dedicated room for taking Orthopantomogram (OPG) X-rays and Cone Beam Computed Tomography (CBCT) scans, a decontamination room for sterilising dental instruments, a staff room/kitchen and a general office.

The practice is owned by an individual who is the principal dentist. 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 eight 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, a dental nurse and two receptionists. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday – Friday 8:45am – 5pm

Our key findings were:

During our initial visit on the 28 September we highlighted serious concerns with regards to medical emergency medicines and equipment, sedation medicines management, safe systems for the provision of dental intravenous sedation and staff training. Our concerns had been rectified by the second visit.

• The practice was clean and well maintained.
• The practice had infection control procedures which reflected published guidance.
• Staff knew how to deal with medical emergencies.
• 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 implemented a safe recruitment process.
• 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.
• 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.

When we visited the service in May 2013 we found improvements were needed in two areas. We noted the dental practice did not have robust systems in place to protect people visiting the service and staff from the risks associated with the spread of infection. We also found some records, required more detail, to better evidence the service was running well.

On this visit we were accompanied by a Specialist Professional Advisor. He was a practising dentist who helps the Care Quality Commission (CQC) with inspections, when necessary. We did not speak with people who use the service on this visit. At our visit in May all those spoken with were very satisfied with the care and treatment they received.

We found the service had improved systems in relation to cleanliness and hygiene practices, in order to better protect people and staff from the risk of harm.

Records kept by the service were more detailed and accurate. They provided better quality information to show the service was running well.

We spoke with three of the four people who had visited the dentist, in private. All were relaxed and able to tell us their experiences. And all spoke positively about the care and support they received, when visiting Fresh Dental Smile Clinic. Their comments included “My appointment was fine. The dentist talked me through everything. Another person told us “I used to hate dentists. I have no worries now though. The care I get is fantastic”

People told us the dentist discussed with them the risks and benefits of the different treatment options and the associated costs. They also confirmed that the dentist obtained their verbal consent, and in some cases they signed their consent for specific treatments.

People told us they received good quality care and didn’t feel rushed during the consultation.

Whilst we noted the service was clean and hygienic and people we spoke with confirmed this, systems in place to minimise the risks of a spread of infection were not robust.

People told us the small staff team were friendly and helpful. People added they thought the staff were competent and trustworthy.

Whilst the provider was in day to day charge of the practice and monitoring how the service was operating some record-keeping could be improved. And we found appropriate records relating to medicines storage were not in place.