We carried out this announced inspection on 27 November 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

Brentwood Orthodontic & Implant Centre is in Brentwood Essex and is a specialist dental practice; their services include dental braces, dental implants, dental implant solutions, oral surgery, sedation services and children's dentistry. The practice provides 35% NHS and 65% private orthodontic treatment for children and adults. Orthodontic treatment is provided under NHS referral for children except when the problem falls below the accepted eligibility criteria for NHS treatment. Private treatment is available for these patients as well as adults who require orthodontic treatment.

There is step access and a portable ramp is available for people who use wheelchairs and those with pushchairs. Car parking spaces, including spaces for blue badge holders, are available near the practice in a multi storey car park.

The dental team includes four dentists with the following specialisms; two specialist orthodontists, an implantologist and an oral surgeon who also provides Intra Venous (IV) sedation. They are supported by three orthodontic therapists, one hygienist, one implant/sedation nurse, one orthodontic nurse and two dental nurses. There are also three receptionists; two who undertake administration duties, one clinical manager/dental nurse and one practice manager. The practice has five treatment rooms, four on the ground floor and one on the first floor. The treatment room on the first floor is no longer in use and is due to be re-developed.

The practice is owned by two individuals who are the principal dentists there. They have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run.

On the day of inspection, we collected 19 CQC comment cards. During the inspection we spoke with two dentists, two dental nurses, one orthodontic therapist, one receptionist, the clinical manager 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 from 8.15am to 6pm.

Tuesday from 8.15am to 7pm.

Wednesday from 8.15am to 4.30pm.

Thursday from 8.15am to 4.30pm.

Friday from 8.15am to 3pm.

Saturdays, 1st and 3rd of each month from 9am to 1pm by appointment.

Our key findings were:

• The practice appeared 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 practice provided sedation to those patients who would benefit.
• 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 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 staff dealt with complaints positively and efficiently.
• The practice had a strong culture of continuous improvement and development.
• The practice asked staff and patients for feedback about the services they provided. Results of feedback were analysed and discussed at staff meetings to share learning. Thank you cards were on display in the waiting room. We noted feedback from patients was wholly positive.

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

• Review the security of NHS prescription pads in the practice and ensure there are systems in place to track and monitor their use.