We carried out this announced inspection on 18 July 2017 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.

We told the NHS England area team and Healthwatch that we were inspecting the practice. They did not provide any information.

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

North Devon Orthodontic Centre is in Barnstaple and provides mostly NHS and some private orthodontic treatment to children and some adults.

There is level access for people who use wheelchairs and pushchairs. Car parking spaces are available at the practice.

The dental team includes two orthodontists, three orthodontist therapists, six dental nurses, four administrators and a practice manager. The practice has four treatment rooms. Two are on the ground floor and two on the first floor. Treatment rooms on each of the floors connect, and contain a chair for an orthodontist and an orthodontic therapist.

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 North Devon Orthodontic Centre was the principal orthodontist.

On the day of inspection we collected 20 CQC comment cards filled in by patients or their parents. This information gave us a positive view of the practice.

During the inspection we spoke with the principal orthodontist, an orthodontist therapist, two dental nurses, the practice manager, a senior manager from the company and three administrative staff. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open: Monday 9am - 7pm, Tuesday 9am - 5pm, Wednesday 8am - 5pm, Thursday 8am - 6pm, Friday 9am - 5pm. The practice is also open one Saturday a month 9am - 4pm. 

Our key findings were:

• The practice was clean and well maintained.
• The practice 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.
• The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• The practice 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 appointment system met patients’ needs.
• The practice had effective leadership. Staff felt involved and supported and worked well as a team.
• The practice asked staff and patients for feedback about the services they provided.
• The practice dealt with complaints positively and efficiently.

There was one area where the provider could make improvements. They should:

• Review procedures for maintaining privacy and confidentiality whilst orthodontic treatments are being carried out.

This was our first inspection of North Devon Orthodontic Centre since dental and dentistry services were required to register with the Care Quality Commission. At this inspection we checked that people using the orthodontic practice had access to examinations in private. We asked people how they were involved in their treatment planning and whether they were invited to give feedback about their experiences. We also looked at the provider’s records to ensure that people received safe and effective treatment in a clean environment. In addition we assessed the provider’s systems for ensuring the confidentiality of patient records.

We visited the practice on 2 October 2012 where we met and spoke with staff and checked records. We also conducted a tour of the premises and observed one person receiving treatment. Following the visit we contacted, with their permission, a selection of people who had attended the practice for assessment or treatment the week preceding our visit. We heard comments from 14 people who had either received treatment themselves or who represented children who had received treatment at practice. People expressed high levels of satisfaction. Comments included;

• ‘When you see my before and after pictures, the results are amazing.’

• ‘They seem to be really nice, friendly and approachable.’

• ‘I thought they were really helpful and very informative.’

• ‘It is always very clean there.’

• ‘They seem very caring and they treat you as an individual.’