We carried out this announced inspection on 12 February 2019 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

Dhillon and Kazemi is situated in a pedestrianised shopping centre in Basildon, Essex and provides NHS and private orthodontic treatment to adults and children. Orthodontics is a specialist dental service concerned with the alignment of the teeth and jaws to improve the appearance of the face, the teeth and their function. 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.

The practice is situated on the second floor of multiorganization premises. There are lifts and level access for people who use wheelchairs and those with pushchairs. Car parking spaces, including spaces for blue badge holders, are available in car parks near the practice.

The dental team includes two specialist orthodontists, one dental nurse, one receptionist/reception manager and one orthodontist therapist/practice manager. The practice has three treatment rooms.

The practice is owned by a partnership 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 Dhillon and Kazemi was the principal orthodontist.

On the day of inspection, we collected 27 CQC comment cards filled in by patients and spoke with one patient.

During the inspection we spoke with two orthodontists, one dental nurse, the receptionist / reception manager and the orthodontist therapist / practice manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open: Monday to Friday from 9am to 5pm.

Our key findings were:

• Strong and effective leadership was provided by the management team which included the two orthodontists, the practice manager and the whole team. Staff felt involved and supported and informed us this was a good place to work.
• The practice appeared clean and well maintained.
• The practice staff had infection control procedures which reflected published guidance. The practice undertook infection control audits every six months. However, the practice manager told us the next audit was overdue and confirmed this would be undertaken. The June 2018 audit showed the practice was meeting the required standards.
• Staff knew how to deal with emergencies. Some medicines and life-saving equipment were available. We found the aspirin was not dispersible and the oropharyngeal airways were not all available as recommended in guidance; those that were available were out of date. We discussed this with the practice manager who assured us they would take immediate action to replace these items.
• The practice had systems to help them manage risk. We found the practice was not always following the practice policy for sharps management and handling. We discussed this with the practice manager and both the orthodontists who agreed to review their sharps procedures.
• The provider had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children. Both orthodontists were trained to level three in safeguarding.
• The practice had thorough staff recruitment procedures. The newest member of staff had been with the practice for six years.
• 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.
• Staff were providing preventive care and supporting patients to ensure better oral health.
• The appointment system took account of 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. Results of feedback were analysed and discussed at staff meetings to share learning.
• The practice staff dealt with complaints positively and efficiently.
• The practice staff had suitable information governance arrangements.

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

• Review the practice’s sharps procedures to ensure the practice is in compliance with the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.
• Review the availability of equipment in the practice to manage medical emergencies taking into account the guidelines issued by the Resuscitation Council (UK) and the General Dental Council.