We carried out this announced inspection on 20 November 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 advisor and a newly recruited specialist dental advisor who was shadowing the inspection.

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

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 this practice was providing safe care in accordance with the relevant regulations.

Are services effective?

We found this practice was providing effective care in accordance with the relevant regulations.

Are services caring?

We found this practice was providing caring services in accordance with the relevant regulations.

Are services responsive?

We found this practice was providing responsive care in accordance with the relevant regulations.

Are services well-led?

We found this practice was providing well-led care in accordance with the relevant regulations.

Background

Cheltenham Orthodontics Limited is situated in a two storey modernised building set on the outskirts of Cheltenham. The practice has its own car park. There is a bus stop near the practice. The practice provides mainly NHS orthodontic treatment to patients of all ages. A small number of private treatments are also provided.

There is level access for people who use wheelchairs and pushchairs from the car park into the ground floor reception area and waiting room. All facilities in the building are accessible for people with a disability.

The dental team includes two orthodontists, two trained dental nurses, two receptionists and a practice manager The practice has two 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 Cheltenham Orthodontics Limited was the principal dentist.

On the day of inspection we collected 48 CQC comment cards filled in by patients and spoke with one other patient. This information gave us a positive view of the practice.

During the inspection we spoke with orthodontists, the two dental nurses, the practice manager and both receptionists. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

·Monday- Friday 08.30am – 5.00pm

·Out of hour’s information displayed on website and via telephone answering service.

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.
• The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• The practice had staff recruitment procedures which reflected the regulatory requirements.
• 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.
• The practice had effective leadership. 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 dealt with complaints positively and efficiently.
• Patients had their treatment peer assessed and rated using the orthodontic peer assessment rating (PAR) index.

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

• Review the storage of dental care products and medicines requiring refrigeration to ensure they are stored in line with the manufacturer’s guidance and the fridge temperature is monitored and recorded.

We spoke with three young people who used the practice and their parents. They made positive comments about the practice and the treatment they had received. One person told us that their treatment had been a “good experience”. People also told us how information about their orthodontic treatment had been explained to them with the person stating this had been “clearly” explained.

There were arrangements in place to protect children and vulnerable adults from the risk of abuse. We found that there were effective procedures in use for the decontamination of dental instruments. In addition everyone we spoke to said that the practice environment was clean when they visited. We also found that quality monitoring systems were in place that included seeking the views of people using the service.