We carried out this announced inspection on 19 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. The inspection was led by a CQC inspector who was supported by a specialist dental adviser.

We told the NHS England area team and Healthwatch that we were inspecting the practice. They did not provide any information of concern.

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

Stable Court Dental Surgery Ltd is in Holmfirth and provides NHS and private treatment to adults and children.

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

The dental team includes six dentists (one of whom is a foundation dentist), 12 dental nurses, two dental hygiene therapists, four receptionists and a practice manager (who is also a qualified dental nurse). The practice has six 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 Stable Court Dental Surgery Ltd was the practice manager.

On the day of inspection we collected 36 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, four dental nurses, one dental hygiene therapist, 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 and Wednesday from 7:30am to 7:30pm

Tuesday from 7:30am to 5:30pm

Thursday from 7:30am to 6:30pm

Friday from 7:30am to 4:30pm

Our key findings were:

• The practice was clean and well maintained.
• The practice 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. Minor improvements could be made to risks associated with Legionella.
• The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• Improvements could be made to the 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.
• Improvements could be made to the process for auditing X-rays and infection prevention and control.

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

• Review the practice’s fire risk assessment and ensure fire drills are carried out and checks on equipment and lighting are recorded.
• Review the current legionella risk assessment and implement the monitoring and recording of water temperatures at both sentinel taps giving due regard to the 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 practice's recruitment policy and procedures to ensure photo identification, Disclosure and Barring Service (DBS) checks and Hepatitis B titre levels are requested and recorded suitably.
• Review the practice’s audit protocols of various aspects of the service, such as radiography and infection prevention and control to help improve the quality of service. The practice should also check all audits have documented learning points and the resulting improvements can be demonstrated.
• Review its complaint handling procedures and ensure contact details of external organisations are included in the response to complaints.

People told us they were happy with the care provided and were fully involved in the decisions about their dental care and treatment needs. People we spoke with told us their dignity was respected and confidentiality was always maintained. People said they had been coming to the dental practice for many years. One person told us, “I make decisions about what I need”. Another person said, “Staff ask me how I would like to be addressed.”

People had thorough, detailed care and treatment plans relating to all aspects of their care needs. We spoke with five people who spoke highly of the service and they told us they were happy with the care and treatment they received. One person told us, “I have no problems with the care.” Another person said, “I have always had excellent service.”

We observed people were cared for in a clean, hygienic environment. There were effective systems in place to reduce the risk and spread of infection. The people we spoke with told us they had no concerns with the cleanliness of the practice.

People were cared for, or treated by, suitably qualified, skilled and experienced staff. Appropriate checks had been undertaken before staff began work. This included carrying out a Criminal Records Bureau check.

There were quality monitoring programmes in place, which included people giving feedback about their care and treatment. This provided a good overview of the quality of the services provided.