We carried out an announced comprehensive inspection on 2 July 2015 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

Orthoplus – The Orthodontic Practice Uxbridge is one of three orthodontic practices operated by Orthoplus LLP. The practice is located in Uxbridge in the London Borough of Hillingdon. The other two practices are located in Northwood in North West London and Hemel Hempstead in Hertfordshire. Each practice is separately registered with the Care Quality Commission (CQC).

The practice premises are laid out over three floors with the entrance, reception and waiting area on the ground floor accessed via a ramp at street level. The treatment room is on the first floor accessed by four stair steps and the administration and storage area located in the basement. The treatment room is open plan with four dental chairs, there is a separate consultation room for privacy. The practice has an in house laboratory for the processing of dental impression models and vacuum formed retainers. (A vacuum formed retainer is a thin brace made from a sheet of clear plastic)

The practice provides NHS orthodontic treatment to patients under 18 years of age who meet the criteria set out in the NHS index of treatment need (IOTN). (The IOTN is a clinical index to assess orthodontic treatment need). Private and Independent  payable treatment is available at the practice to patients under 18 years if they do not meet the NHS IOTN criteria or for those who do not want to go on a waiting list. Private and Independent payable treatment is available for patients over 18 years of age.

The practice is open Mondays to Thursdays from 08.00 am to 5.00 pm and closed for lunch between 1.00 pm to 2.00 pm. Appointment times are from 08.00 am to 12.00 pm alternate Mondays; 08.00 am to 12.00 Tuesdays; 2.00 pm to 5.00 pm alternate Wednesdays and 08.00 am to 4.00 pm Thursdays. The practice is closed on Fridays.

Three orthodontists work at the practice with one in attendance during practice opening hours. Three registered dental nurses who also perform reception duties cover between them during practice opening hours. Clinical staff are supported by a practice manager who is in attendance at the practice one day a week and based at the other practice sites the remaining of the week. The practice manager had recently been appointed to manage the three practice sites and at the time of our inspection had been in post for three months.

The practice changed its registration with the CQC in January 2015 when the registered manager left the company. A registered manager is a person who is registered with the Care Quality Commission (CQC) 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. At the time of our inspection the CQC had not received an application for a new registered manager, but we were told that this would be progressed.

The inspection took place over one day and was carried out by a CQC inspector accompanied by a specialist advisor for orthodontic dentistry.

We received eight CQC comment cards completed by patients and spoke with four families with children that were attending their orthodontic appointments during our inspection visit. We reviewed feedback from NHS Family and Friends Test (FTT) cards completed by patients. Patients we spoke with, and those who completed comment cards, had commented positively about the staff and their experience of being treated at the practice.

Our key findings were:

• The practice had systems to assess and manage risks to patients and staff, including for infection prevention and control health and safety and the management of some medical emergencies including emergency medicines. The practice did not have an automated external defibrillator (AED)

• Equipment, such as the autoclave (steriliser), fire extinguishers and oxygen cylinder were checked for effectiveness and were regularly serviced.

• The practice ensured staff maintained the necessary skills and competence to support the needs of patients.

• Patients indicated that they were able to make appointments when needed and that they received good care carried out by helpful and professional staff.

• Systems were in place to receive patient feedback and improve practise.

• The practice had a clear vision for the services it provided and staff told us they were well supported by the management team.

• There was evidence that the practice audited areas of their practise as part of a system of improvement and learning.

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

• Review availability of equipment to manage medical emergencies giving due regard to guidelines issued by the Resuscitation Council (UK) and the General Dental Council (GDC) standards for the dental team.
• Review the practice’s protocols to store sterilised unwrapped dental instruments giving due regard to guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices.
• Review the availability of necessary equipment for the smooth running of the practice, especially the Orthopantomogram (OPG) X-ray machine to ensure it is in working condition and that patients are not required to travel to another practice for OPG X-rays. (OPG is a panoramic scanning dental X-ray of the upper and lower jaw).
• Review the practice’s protocols for open plan treatment rooms and ensure all reasonable efforts are made to make sure that discussions about care and treatment cannot be overheard.

• Review staff awareness of the requirements of the Mental Capacity Act (MCA) 2005 and ensure all staff are aware of their responsibilities under the Act as it relates to their role.
• Review its audit protocols to ensure audits to review the quality of clinical record keeping are undertaken at regular intervals.
• Review patient information literature to ensure that they reflect up to date information about the practice opening times and the current practice team.

The practice provided orthodontic treatment only and the majority of people attending were children with their parents. We spoke mainly with parents and also with some of the children, and have combined the views of both in our comments.

People said they had been consulted about their treatment and the options available had been explained to them, so they could make an informed choice. People told us they were treated with respect and the initial consultations and planning of treatment took place in private. The treatment area was open-plan and people said they liked this as they could see other people and felt comfortable with this layout. People said the staff were friendly and helpful, and that communication was good.

People told us they could get appointments to fit in with their daily routines. People said they had been asked about their medical and dental histories prior to treatment being given. They told us feedback was given after each appointment. People told us they were given the opportunity to ask questions about the treatment and staff answered them clearly.

People said they were comfortable with the treatment and care they received. Parents said they would feel able to raise any concerns they might have. People told us the practice was clean and hygienic.