Patients told us the staff were polite and respectful and confirmed they always received their treatment in private. One patient said they had been asked their opinion throughout the course of their treatment and another told us they had the options for treatment explained to them so they understood and could make an informed choice.

Patients said their treatment had been explained to them and they had been given the timelines for the progress and completion of the treatment. Patients told us they had completed medical history forms and were asked periodically if there had been any changes, so this could be recorded. Patients said they or their parents had signed a treatment plan to agree to the treatment being carried out.

Patients said they had no concerns but if they were worried about something they would feel confident to discuss it with the staff. Patients confirmed the practice and surgery room were kept clean.

We spoke with four staff and four patients.

We carried out this unannounced inspection on 11 October 2018 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We re-visited the practice on 18 October 2018 to gather further evidence. 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 not providing well-led care in accordance with the relevant regulations.

Background

Orthodontic Centre Hayes is in the London Borough of Hillingdon and provides private orthodontic treatment to adults and children. Orthodontic Centre Hayes has a fee sharing contract with another dental provider for the premises. The orthodontic practice is located on the first floor.

The dental team includes the principal dentist. The principal dentist told us that they had not seen patient within the last six months, There were no other staff members employed at the practice on the day of inspection. We were told that agency nurses and nurses from the other provider will be used if the provider sees patients in the future.

The practice is owned by an individual who is the principal dentist there. They have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run.

At the time of the inspection and for six months preceding it, the provider had not been seeing patients so we were unable to gather any comments. We inspected the practice in response to information shared with us by NHSE.

During the inspection we spoke with the principal dentist. We spoke with the practice manager, principal dentist and one dental nurse from the other location to confirm the current arrangements in place.

The practice is open whenever patients are booked in for treatment

Our key findings were:

• The practice appeared clean and well maintained.
• The principal dentist knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• The practice had systems to help them manage risk. Improvements were needed so that the practice reviewed and learned from external safety alerts and information,
• The practice had suitable safeguarding processes and the principal dentist knew their responsibilities for safeguarding adults and children.
• The practice had arrangements to provide preventive care and supporting patients to ensure better oral health.
• The practice dealt with complaints positively and efficiently.
• The practice had infection control procedures which reflected published guidance.
• Improvements were needed to the arrangements for monitoring the quality of dental radiography.

We identified regulations the provider was not meeting. They must:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

Full details of the regulations the provider was not meeting are at the end of this report.

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

• Review the current staffing levels and ensure the practice can provide routine appointments in a timely manner to its patients.

• Review the practice’s protocols for referral of patients and ensure referrals are monitored suitably.