During our visit to Circus Orthodontic practice we met with the provider and spoke with five members of staff. We spoke with four patients and their parents.

All of the patients we spoke with were very happy with the orthodontic treatment they received. One patient said “it’s been a very good experience. Everyone [the staff] is really helpful. They explained the commitment the treatment would require from me and they explained the reasons behind not being able to drink and eat certain things. I felt informed and I felt they wanted what was best for me”.

Patients said they were involved in their treatment plans and their permission was sought before any treatment started. A parent said “we were referred by the dentist. We talked through the options and what it would mean. The children need to be quite disciplined. The staff stressed the need for the children to make a decision to ‘buy into’ [commit to] the treatment. We were well aware of the long term commitment”. Patients and parents told us they both signed consent forms to have treatment.

Patients we spoke with told us the practice was always clean and tidy, one said “it looks clean and sterile”. We found current infection control guidelines were followed to reduce the risk of infection.

Staff told us they were supported to carry out their roles. We saw from training records the staff received training specific to their job. The practice was in the process of introducing a system of regular staff appraisal.

The practice operated a complaints procedure which was accessible to patients. There had been one complaint in the last year which had been responded to in line with the practice’s policy. We saw that patients had received a full written response with a detailed explanation including information about NHS funding. The practice operated a system to ensure learning from informal complaints was shared.

We visited Circus Orthodontics on 17 September 2012 to follow up the progress made since our last inspection in April 2012 where we set compliance actions. The compliance actions related to Outcome 8 cleanliness and infection control.

We did not speak to people using the service during this visit, because we went to check on the way cleanliness and infection control precaution practice was maintained. We spoke with the senior dental nurse during our visit.

We spoke with three children, and two parents accompanying their children, attending the dental practice for treatment. The children we spoke with told us they had to come every eight to ten weeks for checks and adjustments to their brace. They said that it was easy to make appointments and that the staff were good at trying to fit them in around school activities and lessons. They told us that they liked the dentists saying: ‘he explains what is going to happen, and I think the service is good and all the staff are friendly’. The parents were pleased with the treatment telling us: “the dentist involves the children and always reminds them of the care they need to take of their brace at each visit”.

Although the people we spoke with were happy with the service provided by Mr Kerrigan, we found that some improvements are needed to ensure the practice fully complies with Department of Health infection control guidance.