During our inspection in March 2013 we found that people’s medical histories had not been regularly updated. The provider told us that they had not carried out audits of patient records and we saw that the quality of radiographs had not been audited recently. We also found that staff training records were not kept at the practice. We were told that staff did not have appraisals and that staff meetings were infrequent.

We carried out this inspection in December 2013 to check that the provider had made improvements in these areas.

During this inspection we found that patient record card audits had been carried out and patient medical histories were up to date. We saw records that showed that radiographs were checked for quality.

We found that staff training and appraisal records were kept at the practice and were available to staff. We also saw evidence that the practice held regular staff meetings.

We spoke with three patients who were having treatment on the day of our visit. These patients were happy overall with the treatment that they had received over the time they had been attending the practice. They all felt that their decisions and opinions were respected by the staff and that their privacy and confidentiality had been maintained. One commented that the staff "explained well everything they were doing."

We found that patients were given appropriate information about their treatment. Information was collected and updated about patient's medical conditions to ensure patients remained safe when being treated. Equipment was available and staff trained to

deal with medical and other foreseeable emergencies.

There were effective systems in place to reduce the risk and spread of infection.

There were not suitable arrangements in place in order to ensure that staff were appropriately supported to enable them to deliver care and treatment to people safely and to an appropriate standard through the use of supervision or appraisal.

Patient records were not consistently compiled adequately and there were no audits of patient records or current radiograph. Patient records were stored securely.