We carried out an announced comprehensive inspection on 9 September 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

High Ash Dental Practice is situated approximately five miles north of Leeds, West Yorkshire. It offers mainly NHS dental treatment to patients of all ages but also offers private treatment options. The services include preventative advice and treatment, routine restorative dental care and private orthodontic treatments.

The practice has three surgeries, an orthodontic consultation room, a decontamination room, two waiting areas and a reception area. The reception area, one waiting area and one surgery are on the ground floor. The other two surgeries, the orthodontic consultation room, a waiting area and the decontamination room are on the first floor. There were accessible toilet facilities available on the ground floor of the premises. There was step free access to the premises at the front of the building. Parking is available on the road or behind the premises in a car park.

There are three dentists, three dental nurses, one receptionist and a practice manager (who is also a qualified dental nurse).

The opening hours are Monday, Tuesday and Thursday from 9-00am to 5-30pm, Wednesday from 9-00am to 1-00pm and Friday from 8-30am to 4-00pm.

The practice owner is registered with the Care Quality Commission (CQC) as an individual. 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 30 patients. The patients were positive about the care and treatment they received at the practice. Comments included that staff were helpful, the dentists listened to any concerns and that they were seen quickly for an emergency appointment. They also commented that treatments were well explained and options were discussed.

Our key findings were:

• The practice was visibly clean and uncluttered.
• The practice had systems in place to assess and manage risks to patients and staff including health and safety and the management of medical emergencies.
• Staff were qualified and 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.
• Dental care records showed that treatment was planned in line with current best practice guidelines.
• 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.
• The practice had a complaints system in place and there was an openness and transparency in how these were dealt with.
• Patients were able to make routine and emergency appointments when needed.
• The governance systems were effective.
• There were clearly defined leadership roles within the practice and staff told us that they felt supported, appreciated and comfortable to raise concerns or make suggestions.
• There was no handwashing sink in the orthodontic consultation room.
• There were some inconsistencies when the Infection Prevention Society (IPS) audit was carried out.
• There were some gaps in the recruitment process.

There were areas where the provider could make improvements and should[FA1]:

• Review the availability of handwashing facilities in the orthodontic consultation room.
• Review the practice's protocols for the completion of the IPS audit 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.
• Review the practice's recruitment policy and procedures to ensure proof of identification and immunisation to Hepatitis B are requested and recorded suitably in line with Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 to ensure necessary employment checks are in place for all staff and the required specified information in respect of persons employed by the practice is held.

During the visit we spoke with one patient and we also looked at the dental practice patient feedback surveys. The patient we spoke with confirmed that they had been involved in making decisions about their dental care and treatment options. They said they were given clear information about their treatment and the costs involved. They found the staff to be friendly and reported that they were treated with respect and their privacy was maintained. They said that the practice was clean.

Staff told us they were well supported in their work. They told us they able to access training opportunities. We saw arrangements in place to deal with emergency situations including training for staff in medical emergencies and resuscitation. Patients told us that they were confident that the environment was always well maintained and that all instruments used were clean and sterile. The practice had effective procedures in place for the management of infection control. Staff had received training to reduce the risk of infection. We saw the complaints procedure.

Patients were given support by the provider to make a comment or complaint where they needed assistance. Patients' complaints were fully investigated and resolved, where possible, to their satisfaction.