We carried out this announced inspection on 4 December 2018 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.

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

Pinnacle Orthodontics is in Coventry and provides NHS and private orthodontic treatment to patients of all ages. Orthodontics is a specialist dental service concerned with the alignment of the teeth and jaws to improve the appearance of the face, the teeth and their function. Orthodontic treatment is provided under NHS referral for children except when the problem falls below the accepted eligibility criteria for NHS treatment. Private treatment is available for these patients as well as adults who require orthodontic treatment.

There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces, including one for blue badge holders, are available in the dedicated practice car park. The practice is situated less than a five-minute walk from Coventry train station.

The dental team includes seven dentists, two dental nurses, one trainee dental nurse, two receptionists and one practice manager who is also a qualified dental nurse. The practice has three treatment rooms.

The practice is owned by a partnership 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 Pinnacle Orthodontics is the principal dentist.

On the day of inspection, we collected 29 CQC comment cards filled in by patients.

During the inspection we spoke with two dentists, one dental nurse, one receptionist and the practice manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday from 9am to 5.30pm.

Tuesday from 9am to 6pm.

Wednesday from 9am to 6pm.

Thursday from 9am to 5.30pm.

Friday from 9am to 4.30pm.

The practice offers later appointments to 8pm on alternate Wednesdays.

Our key findings were:

• Effective leadership was provided by the principal dentist and an empowered practice manager.
• Staff we spoke with felt well supported by the principal dentist and practice manager and were committed to providing a quality service to their patients.
• 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 with the exception of the oxygen cylinder which was smaller than recommended by the resuscitation guidelines. The correct size cylinder was ordered following our visit.
• The practice had systems to help them manage risk to patients and staff. There was scope to strengthen the recording and monitoring of patient safety alerts.
• The provider had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children. Several team members including the safeguarding lead were trained to level three in safeguarding. All staff were scheduled to complete level three safeguarding training in January 2019.
• The provider 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 took account of patients’ needs.
• 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 information governance arrangements.

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

• Review the practice’s arrangements for receiving and responding to patient safety alerts, recalls and rapid response reports issued from the Medicines and Healthcare Products Regulatory Agency (MHRA) and through the Central Alerting System (CAS), as well as from other relevant bodies, such as Public Health England (PHE).
• Review the availability of equipment in the practice to manage medical emergencies considering the guidelines issued by the Resuscitation Council (UK) and the General Dental Council.

We spoke with nine people who used the service, or their relatives. One person told us ”They were brilliant." another person told us "The teeth look beautiful."

One person described the dentist as being, "Kind, caring and considerate."

During our visit we looked at the procedures followed by staff for the assessment and treatment of patients. We also looked at how medicine was managed and the procedures in place to keep people who used the service safe.

We saw a health assessment and medical history had been completed for each patient, that was updated during subsequent visits. We saw there was a system in place to alert the dentist to any medical conditions that may affect a patient's treatment, however these were not always updated onto the record keeping system.

The provider did not have an effective system in place to regularly assess and monitor the quality of service that people receive. We saw the practice had undertaken a recent audit in October 2012 on patient record keeping. The manager was unable to show us how the practice had acted on the findings of the audit.

Dental staff were aware of the best practice guidelines set by the Department of Health. This guidance tells dentists how they should decontaminate dental instruments so that they are properly cleaned between patients. We found the practice was following procedures recommended in the guidance.