We carried out this announced inspection on 15 May 2019 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 and a second CQC inspector.

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

Q Dental Care - Clifton known locally as Bristol Orthodontics and the Smile Suite is in Bristol and provides NHS and private treatment to adults and children.

There is level access for people who use wheelchairs and those with pushchairs, including a wheel chair lift. Car parking spaces, including those for blue badge holders, are available near the practice.

The dental team includes six orthodontists, one implant dentist, one dentist who does orthodontic extractions, one periodontist, one restorative dentist, two orthodontic therapists, 11 dental nurses, one trainee dental nurse, one dental hygiene therapist, one treatment coordinator, one head receptionist, two receptionists and one practice manager. The practice has three treatment rooms and one poly clinic with four treatment chairs.

The practice is owned by a partnership/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 Q Dental Care - Clifton known locally as Bristol Orthodontics and the Smile Suite at the time of inspection was the practice manager. A registered manager is legally responsible for the delivery of services for which the practice is registered

On the day of inspection, we collected 23 CQC comment cards filled in by patients and spoke with four other patients.

During the inspection we spoke with three orthodontists, two orthodontic therapists, nine dental nurses, one head dental nurse, one treatment coordinator, one head receptionist, two receptionists, one regulatory officer, one area manager and the practice manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

The Smile Suite

Monday 7.50am to 4.30pm

Tuesday 7.50am to 8pm

Wednesday 7.50am to 6.50pm

Thursday 7.50am to 4.30pm

Friday 7.50am to 1.50pm

Closed Saturday and Sunday

Bristol Orthodontics

Monday 7.50am to 4.30pm

Tuesday 7.50am to 4.30pm

Wednesday 7.50am to 6.50pm

Thursday 7.50am to 4.30pm

Friday 7.50am to 1.50pm

Closed Saturday and Sunday

Our key findings were:

• The practice appeared clean and well maintained.
• The provider had infection control procedures which reflected published guidance, however we found that ventilation appeared insufficient in the decontamination room and throughout the building.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• The practice had systems to help them manage risk to patients and staff.
• The provider had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
• Improvements could be made to the availability of X- ray information.
• Improvements could be made to the administration and testing of the Dental Cone Beam (Computed Tomography) device.
• 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.
• Staff were providing preventive care and supporting patients to ensure better oral health.
• The appointment system took account of patients’ needs.
• Improvements could be made to Control of Substances Hazardous to Health (COSHH) Regulations 2002 file to ensure the safe storage and use of materials used.
• The provider had effective leadership and culture of continuous improvement.
• Improvements could be made to the staff appraisal process.
• Improvements could be made to the auditing processes.
• 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 training, learning and development needs of individual staff members at appropriate intervals and ensure an effective process is established for the on-going assessment, supervision and appraisal of all staff.

• Review the practice’s infection control procedures and protocols taking into account the guidelines issued by the Department of Health in the Health Technical Memorandum 01-05: Decontamination in primary care dental practices, and having regard to The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance’. In particular ventilation and temperature control.

• Review the practice's protocols and procedures for the use of X-ray equipment in compliance with The Ionising Radiations Regulations 2017 and Ionising Radiation (Medical Exposure) Regulations 2017 and taking into account HPA-CRCE-010 Guidance on the Safe Use of Dental Cone Beam (Computed Tomography).

• Review the practice’s protocols to ensure audits of radiography, clinical records, patient care notes and infection prevention and control are undertaken at regular intervals to improve the quality of the service. Practice should also ensure that, where appropriate, audits have documented learning points and the resulting improvements can be demonstrated.

We spoke with three people on the day of our inspection and also looked at feedback gained through the provider's own quality monitoring. People were satisfied with the treatment they'd received and told us it had been well explained to them. One person told us that they'd been able to make an appointment promptly when required.

People were given adequate information and in a suitable format to help them make decisions about their treatment. Consent forms were signed before treatment began.

There were suitable arrangements in place for cleanliness and infection control and these met with the requirements of the HTM 01-05. Staff were supported in their training and development and received an annual appraisal where there training needs were discussed.

There were arrangements in place for monitoring the quality and safety of the service provided and this included gathering feedback. Satisfaction surveys were carried out on an annual basis.