We carried out this announced inspection on 11July 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

Queensway Orthodontic clinic is in Billingham and provides NHS and private orthodontic treatment to adults and children. The orthodontic clinic is a sister practice to Queensway Dental clinic which is spread across two buildings; the main building and opposing “Crown” building. Each building has it’s own reception, waiting area, a dedicated sterilisation suite and patient facilities.

Queensway Orthodontic clinic is located on the upper floor of the “Crown” building and has five treatment rooms. There is level access for people who use wheelchairs and pushchairs. Patients who are unable to ascend the stairs can be seen in their Queensway dental clinic’s ground floor treatment room. Car parking spaces are available, including a multi-storey car park opposite the practice.

The practice provides solely orthodontic treatment to patients – through internal or external referral.

The dental team includes three specialist orthodontists, four orthodontic therapists, an orthodontic service manager, four receptionists, nine dental nurses, three sterilisation technicians, a governance manager, a patient treatment co-ordinator and a business administrative team.

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 managers at Queensway dental clinic are the principal specialist orthodontist and the governance manager.

On the day of inspection, we collected eight CQC comment cards filled in by patients which gave us a positive view of the practice.

During the inspection we spoke with the governance manager, a specialist orthodontist, the treatment advisor, two dental nurses, a sterilisation technician and reception staff.

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

The practice is open Monday to Friday8.30am to 5.30pm.

Our key findings were:

• The practice appeared clean and well maintained.
• The practice had infection control procedures which reflected published guidance.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• The practice had systems to help them manage risks.
• The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• The practice had staff recruitment procedures. The process for undertaking Disclosure and Barring Service (DBS) checks, monitoring immunisation status and other essential recruitment processes required reviewing.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• The appointment system met patients’ needs.
• The practice had effective leadership and culture of continuous improvement.
• Staff felt involved and supported and worked well as a team.
• Staff well-being was evidently a large priority to the partners of the practice. Numerous health and well-being options were available to staff.
• The practice asked staff and patients for feedback about the services they provided.
• The practice dealt with complaints positively and efficiently.
• The practice had suitable information governance arrangements.
• The practice was providing preventive care and supporting patients to ensure better oral health in line with current guidelines.
• Oral health talks were given to various groups (schools, dementia clinics) throughout the region.

We identified areas of notable practice.

• Staff well-being was evidently a priority. Various measures for team building and learning were in place, as well as free access to support groups. In addition, physical aids were provided and exercise events such as yoga and walking also took place.
• Dental nurses involved in orthodontic nursing and assistance were provided with a comprehensive training programme led by a senior dental nurse. This involved one-to-one training and discussion of orthodontic procedures. We saw a training matrix covering a wide range of orthodontic subjects, including an introduction to orthodontics, use of cephalometrics, taking and developing occlusal radiographs, taking photos, intra-oral scanning, retainers and orthodontic record keeping. Each dental nurse was provided with a full one-to-one presentation and ensured sufficient time to understand and develop in the field.

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

• Review the practice's recruitment procedures to ensure accurate, complete and detailed records are maintained for all staff.

We spoke with two people who used the service and the relative of one person. People said that they were very happy with the service they received. They confirmed the dentists, dental nurses, therapists and hygienists always explained what they were doing and what the treatment options were. One person we spoke with told us, “We are told about the costs before any treatment is provided.” They also said, “They are absolutely brilliant, I can’t speak highly enough of them.” A relative we spoke with told us, “I like it, I asked to come here with my daughter. We come all the way from Middlesbrough it’s so good.”

We saw that treatment plans were developed and people’s care was delivered in accordance with their plans.

We found that people were protected from the risk of infection because processes were followed to ensure care was delivered in a clean and hygienic environment.

Arrangements were in place to ensure medicines were handled and administered safely.

We found there was a recruitment procedure in place and appropriate checks were carried out on staff before they started work.

People told us that they would feel comfortable in raising a concern or complaint with staff working at the practice.