We carried out an announced comprehensive inspection on 25 February 2016 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

Shrewsbury Orthodontic Centre is a specialist dental practice providing orthodontic treatment to children and some adults mainly on a referral basis (Orthodontics is a specialist branch of dentistry concerned with the alignment of the teeth and jaws to improve the appearance of the face, the teethand their function). Orthodontic treatment is provided under NHS regulations 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. The practice is situated in a converted residential property, a Grade 2 listed building. The practice had three dental treatment rooms and a separate decontamination room for cleaning, sterilising and packing dental instruments. Also included were a reception and waiting area.

The practice is open 8.45am - 5.00pm Monday to Thursday and Friday 8.45 - 1.30pm. The practice has two specialist dentists known as orthodontists and are supported by four dental nurses, an orthodontic therapist, a practice manager and two receptionists.

The practice manager is the registered manager. A registered manager is a person who is registered with the Care Quality Commission 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.

Before the inspection we sent Care Quality Commission comment cards to the practice for patients to complete to tell us about their experience of the practice. We received feedback from 49 patients. These provided a completely positive view of the services the practice provides. Patients commented on the high quality of care, the caring nature of all staff, the cleanliness of the practice and the overall high quality of customer care.

Our key findings were:

• We found that the practice ethos was to provide patient centred quality orthodontic care.
• Strong and effective leadership was provided by the practice owner and an empowered practice manager.
• Staff had been trained to handle emergencies and appropriate medicines and life-saving equipment was readily available in accordance with current guidelines.
• The practice appeared very clean and well maintained.
• Infection control procedures were robust and the practice followed published guidance.
• The practice had a safeguarding lead with effective processes in place for safeguarding adults and children living in vulnerable circumstances.
• Staff reported incidents and kept records of these which the practice used for shared learning.
• The orthodontists provided care in accordance with current professional guidelines.
• The practice had fully embraced the concept of skill mix to assist in the delivery of effective orthodontic care to patients.
• The service was aware of the needs of the local population and took these into account in how the practice was run.
• Staff recruitment files were organised and complete.
• Staff had received training appropriate to their roles and were supported in their continued professional development (CPD) by the practice owner and practice manager.
• Staff we spoke with felt well supported by the practice owner and practice manager and were committed to providing a quality service to their patients.
• Information from 49 completed Care Quality Commission (CQC) comment cards gave us a completely positive picture of a friendly, caring, professional and high quality service.

As part of our review we spoke with three people and six representatives of people who used Shrewsbury Orthodontic Centre to gain their experiences of the service they received. People we spoke with included a private patient, new patients undergoing treatment, people who had completed their treatment, people with disabilities and a person who had been discharged.

Feedback we gained from people was extremely positive. People we spoke with were very appreciative of the treatment they or their relative had received. They told us their treatment had made a “huge difference” and said they were fully involved in the treatment options made available to them. They said the centre offered a very professional and friendly service, comments included:

“The treatment I have had has been absolutely impeccable; I’m extremely pleased with it.”

“I’m very very happy; I have nothing but praise for the place.”

“They use easy to understand language and the assessment was very thorough”.

People told us their initial assessment was thorough and included taking photographs, radiographs (X-rays), impressions and an oral health assessment. They said they were given lots of opportunities to ask questions to ensure the appropriate course of treatment. They said they were provided with detailed information to make an informed decision about their treatment options.

People told us they were “very” satisfied with the service they or their relative had received and would “definitely” recommend the practice to other people requiring treatment.

We spoke with four staff to include the specialist orthodontist. Discussions clearly evidenced they were very passionate about their work and were centred on the individual needs of the people who used the service. One person said, “It’s a great job and it’s very rewarding.” People who used the service and their representatives considered staff were competent in their work, were friendly and very helpful.

People we spoke with expressed no concerns in relation to hygiene of the practice. One person said, “It’s absolutely spotless.” They confirmed that clinical staff always wore personal protective clothing such as a uniform, gloves and eye protection to reduce the risk of cross infection.