We carried out this announced inspection on 3 January 2019 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 not 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 not providing well-led care in accordance with the relevant regulations.

Background

Genix Healthcare Dental Clinic – Garforth provides NHS and private treatment to adults and children.

There is one small step at the front entrance to the practice. The provider has a portable ramp available to facilitate access to the practice for wheelchair users and for pushchairs. Car parking spaces are available near the practice.

The dental team includes eight dentists, seven dental nurses, one dental hygiene therapist, three receptionists and a practice manager. The practice has eight treatment rooms.

The practice is owned by a company and as a condition of registration must have a person registered with the Care Quality Commission as the registered manager. Registered managers have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run. The registered manager at Genix Healthcare Dental Clinic – Garforth is the operations manager.

On the day of inspection, we collected 31 CQC comment cards filled in by patients.

During the inspection we spoke with three dentists, three dental nurses, one dental hygiene therapist, one receptionist, the practice manager and the operations manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday and Thursday from 8:45am to 5:00pm

Tuesday and Wednesday from 8:45am to 7:30pm

Friday from 8:45am to 4:00pm

Saturday from 8:45am to 2:00pm

Our key findings were:

• The practice appeared clean and well maintained.
• The provider had infection control procedures which generally reflected published guidance. Minor improvements could be made to some processes.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available. Out of date automated external defibrillator (AED) pads had not been removed from the machine.
• The processes in place to help manage risks associated with Legionella and the use of radiation were not effective.
• The practice’s safeguarding processes were not effective and safeguarding referrals were not made in a timely manner.
• Staff recruitment procedures were not operated effectively.
• The clinical staff provided patients’ care and treatment in line with current guidelines.
• Staff treated patients with dignity and respect. Conversations between the upstairs surgeries could be overheard.
• Staff were providing preventive care and supporting patients to ensure better oral health.
• The appointment system took account of patients’ needs.
• There was lack of oversight of governance arrangements and inadequate management of risk.
• The provider asked patients for feedback about the services they provided.
• The provider dealt with complaints positively and efficiently. Complaints were not always acknowledged in line with the practice’s complaints policy.

We identified regulations the provider was not complying with. They must:

• Ensure care and treatment is provided in a safe way to patients
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care

Full details of the regulations the provider was not meeting are at the end of this report.

We saw patient’s records and other records relevant to the management of the service were in place and accurately maintained.

Patients told us 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 treatment.

We saw that the patients’ survey conducted by Genix confirmed that patients were overall happy with the cleanliness of the building. We spoke with patients who confirmed they did not have any concerns about the cleanliness of the surgery. We observed the standard and management of cleanliness in the practice was good.

We found that there was enough staff working at the practice to meet the needs of the patients safely. Staff told us they felt well supported and could seek advice or support at any time. We also saw that training was in place to help staff to effectively deliver their role. We found patients were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

We spoke with four people who used the service and they all said they were happy with the care and treatment they had received at the dental practice.

We received the following comments:

“The dentist always goes through everything, and there is plenty of information around such as leaflets and information on the walls.”

“They are exceptionally caring, and explain the process very well. I had some work done which required several visits and they brought me in at every stage and checked I was comfortable.”

“They are very thorough. They ask if I have any questions, go through my medical history and check I’m happy with everything.”

“I had a few problems and needed to make some serious decisions. The dentist suggested getting a second opinion which helped me. It’s a very professional service.”

“The customer care is very good.”

“Everyone is very nice. The dentist has always been lovely.”

“I recommended them to the rest of my family because they were so good.”

“They were excellent when they helped a family member who has a dental phobia.”

“The treatment has been of a very high standard.”

“It’s always spotless.”

Patient surveys showed there was a high level of satisfaction with the practice.

We spoke with six staff which included dental nurses, a dentist and the registered manager. They told us people received good care and treatment, and their needs were appropriately met. Staff told us people were involved in the planning of their treatment and good systems were in place to make sure people’s privacy, dignity, and confidentially were maintained.