We carried out this announced inspection on 17 July 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

Perfect Smile Clinic- York provides NHS and private treatment to adults and children.

There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces, including one for blue badge holders, are available next to the practice.

The dental team includes five dentists, one dental hygiene therapist and seven dental nurses and a practice manager. The practice has five treatment rooms. Perfect Smile Clinic- York is a training practice for foundation dentists.

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 Perfect Smile Clinic- York is the principal dentist.

On the day of inspection we collected 21 CQC comment cards filled in by patients.

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

The practice is open:

Monday & Thursday 9:45am - 8pm

Tuesday, Wednesday & Friday 9am - 5pm

Saturday 9am - 12:30 pm.

Our key findings were:

• The practice was clean and well maintained.
• The practice staff 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.
• The practice staff had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• The practice had thorough staff recruitment procedures.
• 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. We saw that Closed Circuit Television (CCTV) was fitted within the premises but recognised guidance had not been adhered to.
• The practice 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 practice staff dealt with complaints positively and efficiently.
• The practice staff had suitable information governance arrangements.

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

• Review the practice’s protocols for the use of closed-circuit television cameras taking into account the guidelines published by the Information Commissioner's Office.

We carried out an unannounced focused inspection on 10 March 2017 to ensure the practice was providing safe care in respect of the regulations; we did not inspect other aspects of the service.

Our findings were:

Are services safe?

We found that this practice was providing safe care in accordance with the relevant regulations. Detailed feedback was given to the practice during and following the inspection and this resulted in a comprehensive action plan being developed and acted upon within a short timescale to address the concerns.

Background

Perfect Smile Clinic is located in Acomb, York and provides NHS and private treatment to adults and children.

Wheelchair users or pushchairs can access the practice through step free access. Car parking spaces are available at the practice.

The dental team is comprised of five dentists, ten dental nurses (including four trainee dental nurses), a dental hygiene therapist and a practice manager.

The practice has five surgeries two on the ground floor and three on the first floor with a waiting area on each floor, a decontamination room, a staff room/kitchen and a general office.

The practice is open:

Monday & Thursday 9:45am - 8pm

Tuesday, Wednesday & Friday 9am - 5pm

Saturday 9am - 12:30 pm.

The principal dentist is the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. 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.

Our key findings were:

• Some of the treatment rooms were cluttered.
• Staff had been trained to handle emergencies and appropriate medicines and life-saving equipment were readily available in accordance with current guidelines.
• Staff understood and received safeguarding training and knew how to recognise signs of abuse and how to report it.
• The decontamination process required improvement and dental instruments were not always bagged in line with HTM 01-05 guidance.
• There were sufficient numbers of suitably qualified staff to meet the needs of patients.
• The appointment system met patients’ needs.
• The practice had procedures in place to record, analyse and learn from significant events and incidents which required improvement.

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

• Review the practice’s infection control procedures and ensure protocols are suitable 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 and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance’.
• Review the security of prescription pads in the practice and ensure there are systems in place to monitor and track their use.
• Review the practice’s responsibilities as regards to the Control of Substance Hazardous to Health (COSHH) Regulations 2002, and ensure all documentation is up to date and staffs understand how to minimise risks associated with the use of and handling of these substances. Review the storage of products identified under (COSHH) Regulations to ensure they are stored securely.
• Review the practice is in compliance with its legal obligations under Ionising Radiation Regulations (IRR) 1999 and Ionising Radiation (Medical Exposure) Regulation (IR(ME)R) 2000.
• Review the practice has an effective system to assess, monitor and mitigate the various risks arising from undertaking of the regulated activities including implementing the actions from risk assessments and audits.

People told us that they had their treatment options explained and were asked to give their consent to their care and treatment. Records looked at during our visit confirmed this.

All of the people we spoke with said that they received good standards of care at the practice. One person told us "This is the best dentist I have been to in years."

We observed the practice was clean and well maintained and this was confirmed by the patients we interviewed. The practice manager showed us the the decontamination cycle. The provider was meeting essential requirements of HTM01-05 and had plans in place to meet best practice.

There were effective recruitment procedures in place and all staff received training to help keep their skills and knowledge up to date. Staff told us that they liked working at the practice and received good support.

The practice had good quality monitoring systems in place which helped to ensure that patients views and experiences were taken into account and acted upon. None of the patients we spoke with suggested any areas which needed to be improved upon.