We carried out this announced inspection on 30 April 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

Mydentist - Orthodontic Centre - Malvern provides NHS and private 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.

There is access into the practice for people who use wheelchairs and those with pushchairs using a portable ramp. Car parking spaces, including some for blue badge holders, are available near the practice.

The dental team includes three dentists, four dental nurses, two trainee dental nurses, two orthodontic therapists, two receptionists and the practice manager. The practice has three 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 Mydentist - Orthodontic Centre - Malvern is the practice manager.

On the day of inspection, we collected 13 CQC comment cards filled in by patients and spoke with two patients.

During the inspection we spoke with one dentist, three dental nurses, two receptionists, the area development manager, the regulatory officer 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 8.30am to 6pm.

Tuesday from 8.30am to 5.30pm.

Wednesday from 8.30am to 5pm.

Thursday from 8.30am to 5pm.

Friday from 8.30am to 4.30pm.

Our key findings were:

• The practice was part of a large corporate group which had a support centre located in Manchester where support teams including human resources, IT, finance, health and safety, learning and development, clinical support and patient support services were based. These teams supported and offered expert advice and updates to the practice when required.
• The practice appeared clean and well maintained.
• 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.
• The practice had systems to help them manage risk to patients and staff.
• The provider had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
• The provider had staff recruitment procedures and had access to support from a dedicated human resources and recruitment team based within the company’s support centre. We found that not all recruitment documents were retained.
• 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.
• The provider had effective leadership and culture of continuous improvement.
• Staff felt involved and supported and worked well as a team. There was an effective staffing structure which extended to senior management who were visible and supported the practice manager on the day of our visit by basing themselves at the practice.
• The provider asked staff and patients for feedback about the services they provided. Appraisals had not been completed annually in accordance with the company policy, these had been scheduled for completion in 2019.
• The provider dealt with complaints positively and efficiently.
• The provider had suitable information governance arrangements.

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

• Review the practice's recruitment policy and procedures to ensure accurate, complete and detailed records are maintained for all staff.
• Review the training, learning and development needs of individual staff members at appropriate intervals and ensure an effective process is established for the on-going assessment, supervision and appraisal of all staff.

We spoke with six people who attend Malvern Orthodontic Centre by telephone following our visit. Some of these people were parents of children and some were adults who had chosen to have orthodontic treatment later in life. Everyone we spoke with was positive about the service that they or their children received and spoke highly of the dentists, dental nurses and reception staff. People used words such as, “exceptional” and, “brilliant” to describe the quality of the service. One person told us, “they are very nice with the children. You can see the children are relaxed”.

One person sent us an email in which they told us, “we are always made to feel welcome at the practice; all of the staff are so welcoming and professional at all times. When the kids have been nervous about treatment they have been reassured by both the dental nurse and the orthodontist who is just wonderful with the kids.” An adult who had been treated at the practice told us they had appreciated the courtesy shown them and said, “they are reassuring, efficient and knowledgeable”

We asked people whether their dentist gave them clear information about the dental care and treatment they or their children needed and any costs involved in this. People told us that everything was explained to them well and that the dentists involved the children in discussions as well as their parents. The dentists we spoke with told us that it is very important to involve the young people in discussions about their orthodontic treatment. This was to show them respect and to make sure they realised the commitment they needed to make.

People confirmed that the dentists and dental nurses wore protective clothing such as face masks and gloves. They said that they were given protective goggles to wear during their treatment. People told us that the practice was always clean and hygienic.