We carried out an announced comprehensive inspection on 6 December 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 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

Only Orthodontics is situated in Huddersfield, West Yorkshire. The practice offers orthodontic treatments on both the NHS and on a private basis.

The practice has two open plan surgeries, a decontamination room, a waiting area and a reception area. The reception area and waiting area are on the ground floor. The open plan surgeries, X-ray room and decontamination room are on the first floor. There are staff facilities on the second floor.

There are five orthodontists, two orthodontic therapists, seven dental nurses (three of whom also cover reception duties), two receptionists and a practice manager.

The opening hours are Monday to Thursday from 8:30am to 5:30pm and Friday from 8:30am to 1:00pm.

One of the partners is the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. 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.

During the inspection we spoke with four patients and reviewed 14 completed CQC comment cards. The patients were positive about the care and treatment they received at the practice. Comments included staff were supportive, caring and sympathetic. They also commented the premises were clean and hygienic, they were well informed about treatment options and were good at putting children at ease.

Our key findings were:

• The practice was visibly clean and uncluttered.
• Staff were qualified and had received training appropriate to their roles.
• Several dental nurses had extended duties including impression taking, radiography and oral health education.
• Patients were involved in making decisions about their treatment and were given clear explanations about their proposed treatment including costs, benefits and risks.
• Dental care records showed treatment was planned in line with guidance from the British Orthodontic Society.
• We observed patients were treated with kindness and respect by staff.
• Staff ensured there was sufficient time to explain fully the care and treatment they were providing in a way patients understood.
• The practice had a complaints system in place and there was an openness and transparency in how these were dealt with.
• Patients were able to make routine and emergency appointments when needed.
• There were clearly defined leadership roles within the practice and staff told us they felt supported, appreciated and comfortable to raise concerns or make suggestions.
• There was appropriate equipment for staff to undertake their duties.
• Governance arrangements required improvement. Some policies were not available, some were not as detailed as they should be and others had not been updated since 2012.
• The practice had not carried out a general risk assessment of the premises.

There were areas where the provider could make improvements and should:

• Review the integrity of the upholstery of the dental nurse’s chairs to ensure they are easily cleanable.
• Review the practice's governance arrangements to ensure all policies are available and kept up to date.
• Review the practice’s process to assess, monitor and mitigate the various risks arising from undertaking of the regulated activities.

Everyone we spoke with as part of this inspection told us they were happy with the quality of care and treatment they received. People told us they felt involved in making decisions about their treatment and had been given sufficient information to make an informed decision.

We looked around the premises and saw treatment areas were clean and staff were wearing personal protective equipment such as gloves. We saw there were clear infection prevention and control measures in place, particularly in the decontamination of dental equipment.

Due to the layout of the practice, we observed some people receiving orthodontic treatment. We observed staff were polite to people explaining the treatment they were providing and the reason for it. When a young person brought a parent/guardian with them, we observed staff explained the treatment to both the young person and the parent/guardian.