We carried out this announced inspection on 6 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

Holywell House Rugby 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.

In addition to this the practice accepts NHS and private minor oral surgery referrals, private endodontic referrals and private periodontal referrals for adults and children.

There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces are available on the streets near to the practice.

The dental team includes seven dentists with the following specialisms; two orthodontists, one dentist with a special interest in orthodontics, two oral surgeons, one dentist with a special interest in endodontics and one dentist with a special interest in periodontology. These are supported by one orthodontic therapist, ten dental nurses, two receptionists, one administrator, one administrative manager, one clinical manager and a business manager. The practice has three treatment rooms.

The practice is part of a group of four practices which are 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 Holywell House Rugby is the business manager.

On the day of inspection, we collected 14 CQC comment cards filled in by patients and looked at recent patient satisfaction survey responses.

During the inspection we spoke with one dentist who is a specialist orthodontist, two dental nurses, one receptionist, one clinical manager and the business manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday from 9am to 5pm.

Tuesday from 9am to 5pm.

Wednesday from 9am to 6pm.

Thursday from 9am to 5pm.

Friday from 9am to 3pm.

Occasional Saturdays from 8am to 3pm.

Our key findings were:

• Strong and effective leadership was provided by the management team which included the principal dentist, business manager, clinical manager and the administrative manager. Staff felt involved and supported and informed us this was a good place to work.
• The practice appeared clean and well maintained. Cleaning schedules were in place and the standard of cleaning was audited monthly by the clinical manager.
• The provider had infection control procedures which reflected published guidance.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available with the exception of the oxygen cylinder which was smaller than recommended by the resuscitation guidelines. The correct size cylinder was immediately ordered following our visit.
• The practice had systems to help them manage risk to patients and staff.
• The practice staff had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children. Several team members including the safeguarding lead were trained to level three in safeguarding.
• The provider had thorough staff recruitment procedures.
• 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 provider was providing preventive care and supporting patients to ensure better oral health. Several dental nurses had completed oral health education training to support patients with oral health and tooth brushing advice.
• The appointment system met patients’ needs.
• 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.
• The provider dealt with complaints positively and efficiently.
• The provider had suitable information governance arrangements.