We undertook a focused inspection of Osborne Orthodontics / Osborne Family Dentists – North Shields on 30 April 2019.

This inspection was carried out to review in detail the actions taken by the registered provider to improve the quality of care and to confirm that the practice was now meeting legal requirements.

The inspection was led by a CQC inspector who was supported by a specialist dental adviser.

We undertook a comprehensive inspection of Osborne Orthodontics / Osborne Family Dentists – North Shields on 27 November 2018 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We found the registered provider was not providing safe and well-led care and was in breach of regulations 12, 17, 18 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

You can read our report of that inspection by selecting the 'all reports' link for Osborne Orthodontics / Osborne Family Dentists – North Shields on our website www.cqc.org.uk.

As part of this inspection we asked:

• Is it safe?

• Is it well-led?

When one or more of the five questions are not met we require the service to make improvements and send us an action plan. We then inspect again after a reasonable interval, focusing on the areas where improvements were required.

Our findings were:

Are services safe?

We found this practice was providing safe care in accordance with the relevant regulations.

The provider had made improvements in relation to the regulatory breaches we found at our inspection on 27 November 2018.

Are services well-led?

We found this practice was providing well-led care in accordance with the relevant regulations.

The provider had made improvements in relation to the regulatory breach we found at our inspection on 27 November 2018.

Background

Osborne Orthodontics is in North Shields and provides NHS and private treatment to adults and children. Most of treatment provided within the practice is orthodontic although a small amount of general dentistry is also carried out. The dental practice is on the first floor of a shared building. Access to the first floor is via a staircase and this is made known to patients in the practice leaflet. Car parking spaces are available near the practice. There is one large treatment room with two dental chairs and an office area within. A decontamination and X-ray room are adjoined to the treatment room. There is a separate reception and waiting area.

The dental team consists of two principal dentists (one of whom is a specialist orthodontist), two dental nurses, a decontamination assistant, a practice manager who is also a qualified dental nurse, and two receptionists.

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 Osborne Orthodontics is one of the principal dentists.

During the inspection we spoke with one of the principal dentists, a dental nurse and the practice manager.

The practice is open for treatment between 9am and 8pm Monday to Saturday on a “by appointment only basis”.

We looked at practice policies and procedures and other records about how the service is managed.

Our key findings were:

• The practice had more efficient leadership in place.
• Medical emergency drugs and equipment were now available in accordance with national guidance.
• The systems to help manage risk to patients and staff had mostly improved. The provider had not implemented all of the recommendations from their fire risk assessment.
• The provider had improved their staff recruitment procedures. They needed to review their systems to make sure they undertook all required checks.
• The system to monitor staff training was not robust.
• Policies were re-written and updated where applicable.
• The practice had closed-circuit television (CCTV) on the premises; a policy had been created. There was no data protection impact assessment in place.
• Improvements were found in some of the practice’s audit and quality assurance processes; these were inconsistent.
• Most issues identified during our inspection on the 30 April 2019 were addressed promptly.

There were areas where the provider could make improvements. They should:

• Review the fire safety risk assessment and ensure that any actions required are complete and ongoing fire safety management is effective.
• Review the practice’s protocols for ensuring that all clinical staff have adequate professional indemnity and immunity for vaccine preventable infectious diseases.
• Review staff training to ensure that all the staff have received training, to an appropriate level, in the safeguarding of children and vulnerable adults.

We carried out this announced inspection on 27 November 2018 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We planned the inspection, in response to concerns received, to check whether the registered provider was meeting the legal requirements in the Health and Social Care Act 2008 and associated regulations. This 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 not 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

Osborne Orthodontics is in North Shields and provides NHS and private treatment to adults and children. Most of treatment provided within the practice is orthodontic although a small amount of general dentistry is also carried out. The dental practice is on the first floor of a shared building. Access to the first floor is via a staircase and this is made known to patients in the practice leaflet. Car parking spaces are available near the practice. There is one large treatment room with two dental chairs and an office area within. A decontamination and X-ray room are adjoined to the treatment room. There is a separate reception and waiting area.

The dental team consists of two principal dentists (one of whom is a specialist orthodontist), two dental nurses, a decontamination assistant, a practice manager who is also a qualified dental nurse, and two receptionists. The practice manager was recently recruited and is currently undergoing induction.

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 Osborne Orthodontics is one of the principal dentists.

On the day of inspection, we collected 23 CQC comment card filled in by patients. These provided an overall positive view of the practice, with some patients’ commenting on long waiting times.

During the inspection we spoke with the two principal dentists, two dental nurses, two receptionists and the practice manager.

The practice is open for treatment between 9am and 8pm Monday to Saturday on a “by appointment only basis”.

We looked at practice policies and procedures and other records about how the service is managed.

Our key findings were:

• The practice appeared clean and well maintained.
• The provider had infection control procedures which reflected published guidance.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available apart from three items. These were ordered the following day.
• The systems to help manage risk to patients and staff needed improvement.
• The provider’s safeguarding systems needed to be improved.
• The provider had staff recruitment procedures which did not follow national guidance.
• 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. A closed-circuit television system (CCTV) was in operation within the corridor, treatment room and waiting room. Signs were displayed to make people aware of the CCTV. The provider did not have a CCTV policy, nor had carried out a data protection impact assessment, in line with the General Data Protection Regulation (GDPR).
• Staff were providing preventive care and supporting patients to ensure better oral health.
• The appointment system took account of patients’ needs.
• The provider could not demonstrate effective leadership.
• Staff felt involved and supported and worked well as a team.
• The provider asked staff and patients for feedback about the services they provided.
• The provider dealt with complaints positively and efficiently.
• The provider had suitable arrangements for the safe storage of clinical records.

We identified regulations the provider was not complying with. They must:

• Ensure care and treatment is provided in a safe way to patients.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
• Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out the duties.
• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.

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

There were areas where the provider could make improvements. They should:

• Review the practice’s protocols for the use of closed circuit television cameras taking into account the guidelines published by the Information Commissioner's Office.
• Review the practice's responsibilities to take into account the needs of patients with disabilities and to comply with the requirements of the Equality Act 2010.
• Review the practice’s systems for environmental cleaning taking into account the guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices and the current national specifications for cleanliness in the NHS.

We spoke with five people whose children had used the service and they told us their treatment had been thoroughly explained and the staff were very reassuring. Comments included, "He (the dentist) explained every to me and X and asked if we had any questions" and "We were given enough information and everything was explained."

People were complimentary about the care and support they received at the centre. They said, "X had a brace fitted and he explained what would happen at each appointment," "He explained what would happen if Y did not wear the brace" and "Z was very nervous at first but he slowed down the pace to suit Y and then we received information about what to expect afterwards and what foods to avoid."

We found the premises were clean, hygienic and the staff were fully aware of the procedures to follow to maintain this. People said they always found the practice clean and hygienic.

We found people were cared for by staff who were trained and supported to carry out their role in a competent manner. The people we spoke with told us that they felt confident the staff could meet their needs.

Our findings of compliance for all essential standards that we inspected, indicated that the quality auditing of the service was sufficient to protect the health, safety and welfare of the people who used it. People were positive about the quality of the service they received. They felt that staff took account of their needs and wishes when providing treatment.