We carried out an announced comprehensive inspection on 2 August 2016 to ask the practice the following key questions; Are services safe, effective, caring, responsive and well-led?

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

The practice is situated near the centre of Taunton and has a waiting/reception room, five treatment areas, a decontamination room, administrative offices, a patient consultation room and a disability toilet. Parking is available in a car park adjacent to the practice. The practice has two specialist orthodontic dentists, two orthodontic therapists, two clinical assistants, four qualified dental nurses, two trainee dental nurses, four receptionists, a treatment coordinator and a practice manager. The practice is a specialist dental surgery providing orthodontic treatment to adults and children through the NHS and privately. Orthodontics is the branch of dentistry concerned with growth and development of orofacial structures, including irregularities of teeth, malocclusion, and associated facial problems. The practice also provides a facial aesthetics service on a private basis for adults.

The practice is open: Monday 08.30am-8.00pm, Tuesday-Thursday 08.30am-5.30pm, and Friday 08.30am – 1.00pm.The practice is closed at the weekend.

The practice is registered with the Care Quality Commission (CQC) as a limited company and has a registered manager. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the practice is run.

We received feedback from 31 patients about the service. The 27 CQC comment cards seen and four patients spoken with reflected very positive comments about the staff and the services provided. Patients commented the practice appeared clean and tidy and they found the staff very caring, friendly and professional. They had trust and confidence in the dental treatments and said explanations from staff were clear and understandable. They told us appointments usually ran on time and they would highly recommend the practice.

Our key findings were:.

• There were systems in place to help ensure the safety of staff and patients. These included safeguarding children and adults from abuse, maintaining the required standards of infection prevention and control and responding to medical emergencies.

• The dental practice had effective clinical governance and risk management processes in place; including health and safety and the management of medical emergencies.

• The practice had a comprehensive system to monitor and continually improve the quality of the service; including through a detailed programme of clinical and non-clinical audits.

• Premises were well maintained and a tour of the building confirmed that good cleaning and infection control systems were in place. The treatment rooms were well organised and equipped, with good light and ventilation.

• There were systems in place to check all equipment had been serviced regularly, including the air compressor, autoclave, fire extinguishers, oxygen cylinder and the X-ray equipment.

• There were sufficient numbers of suitably qualified staff who maintained the necessary skills and competence to support the needs of patients.

• There were sufficient numbers of suitably qualified and skilled staff to meet the needs of patients.

• Specialist orthodontic dental care was provided in accordance with current legislation, standards and guidance.

• Patients’ care and treatment was planned and delivered in line with evidence based guidelines, best practice and current legislation within their specialist field.

• Patients received clear explanations about their proposed treatment, costs, benefits and risks and were involved in making decisions about it.

• Patients were treated with dignity and respect and their confidentiality was maintained.

• The appointment system met the needs of patients and waiting times were kept to a minimum.

• The practice staff felt valued, involved and worked as a team.

• The practice took into account any comments, concerns or complaints and used these to help them improve the service provided. We observed some complaints were not always dealt with in a timely manner.

• Common themes from the CQC comment cards were patients felt they received excellent care in a clean environment from a helpful practice team.

• Dentists, therapists and dental nurses all had specialist skills supported by enhanced skills training. They worked well as a team supporting each other and were able to undertake extended roles such as in radiography and taking impressions.

• The role of a patient coordinator to ensure patients fully understood their treatment options.

• 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 process of appraisal and monitoring individual personal development plans (PDP’s).

• Review the practice’s system for the investigating and resolving complaints in a timely manner.

• Review the process for updating the Control of Substances Hazardous to Health (COSHH) file.

This inspection was to follow up compliance actions issued at the last inspection on 4 October 2013. The provider sent us an action plan and told us they would be compliant by February 2014.

We found the practice had made improvements to meet the compliance actions set. This meant the provider had reduced the risk of people acquiring an infection or cross contamination because they now followed appropriate guidance and made improvements to the environment.

We did not need to speak with people who used the service on this occasion.

During our inspection we spoke with the treatment co-ordinator, an orthodontic therapist, two dental nurses and a dentist. We spoke with five people who used the practice to gain their views of the service. We looked at four individual dental treatment records to see how people’s treatment was planned and delivered. We also looked at three staff files to review how staff were appraised and trained. We saw how the practice cleaned and sterilised dental equipment.

People spoken with were impressed with the treatment received when visiting Orthoworld 2000 Taunton. One person said “its brilliant, staff are always welcoming, always seen within 5 minutes of arriving, X (orthodontist) is really good, I have had good results”. Another person said “they put you at ease and are nice to talk to”.

People told us they could express their views and make informed decisions about their treatment. People’s treatment records showed how their treatment was planned and delivered. There were suitable arrangements in place to deal with medical emergencies.

Staff felt supported and received training relevant to their role.

The practice did not always follow guidelines to ensure they were protecting people from the risk of infections.

At the time of the inspection this practice did not have a registered manager. The acting manager had been in post for over a year. However, they had not applied to the commission to register with us, as required. The practice manager informed us that they were in the process of completing their application to register.