We carried out a desk based follow- up inspection of Smile Orthodontics Yorkshire on 1 December 2017.

We had undertaken an announced comprehensive inspection of this service on 24 August 2017 as part of our regulatory functions where a breach of legal requirements was found

After the comprehensive inspection, the practice manager wrote to us to say what they would do to meet the legal requirements in relation to the breach. This report only covers our findings in relation to that requirement.

We reviewed the practice against one of the five questions we ask about services: is the service well led? You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Smile Orthodontics Yorkshire on our website at www.cqc.org.uk.

We revisited 1 December 2017 as part of this review and checked whether they had followed their action plan and to confirm that they now met the legal requirements. We carried out this announced desk based inspection 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.

To get to the heart of patients’ experiences of care and treatment, we asked the following question:

• Is it well-led?

This question forms the framework for the areas we look at during the inspection.

Our findings were:

Are services well-led?

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

Background

Smile Orthodontics Yorkshire is in Scarborough and provides NHS orthodontic treatment to children and minimal private treatment to adults.

There is level access for people who use wheelchairs and pushchairs. Car parking spaces, including space for patients with disabled badges, are available near the practice.

The dental team includes two orthodontists, four dental nurses who also cover reception and a practice manager.

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 Smile Orthodontics Yorkshire was one of the partners.

We spoke with the practice manager and asked for supporting information to be sent to the inspection to show where improvements had been made.

The practice is open:

Monday – Friday 9am – 5pm.

Our key findings were:

• The practice had suitable safeguarding processes. We found all staff knew their responsibilities for safeguarding adults and children.
• 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. We were told staff felt supported and listened to.
• The practice asked staff and patients for feedback about the services they provided. We were told this was now acted upon.

We carried out this announced inspection on 24 August 2017 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.

We told the NHS England area team and Healthwatch that we were inspecting the practice. We did receive information of concern from them which we took into account.

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 not providing well-led care in accordance with the relevant regulations.

Background

Smile Orthodontics Yorkshire is in Scarborough and provides NHS orthodontic treatment to children and minimal private treatment to adults.

There is level access for people who use wheelchairs and pushchairs. Car parking spaces, including space for patients with disabled badges, are available near the practice.

The dental team includes three orthodontists, four dental nurses who also cover reception and a practice manager.

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 Smile Orthodontics Yorkshire was one of the partners.

On the day of inspection we collected seven CQC comment cards filled in by patients. This information gave us a positive view of the practice.

During the inspection we spoke with two orthodontists, three dental nurses, the registered manager, the practice co-ordinator 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 – Friday 9am – 5pm.

Our key findings were:

• The practice was 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 risk.
• The practice had suitable safeguarding processes. We found not all staff knew their responsibilities for safeguarding adults and children.
• The practice had thorough staff recruitment procedures.
• The Orthodontists carried out an assessment in line with recognised guidance from the British Orthodontic Society (BOS).
• Most 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 did not have effective leadership. We were told staff did not always feel supported.
• The practice asked staff and patients for feedback about the services they provided. We were told this was not always acted upon.
• The practice dealt with complaints positively and efficiently.

We identified regulations the provider was not meeting. They must:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

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 infection control procedures and protocols to take into account guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices and have regard to The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance’.

• Review practice's safeguarding policies and staff training. Ensuring all staff are aware of their responsibilities.
• Review current policies and procedures for obtaining patient consent to care and treatment and ensure they reflect current legislation and guidance, and that staff follow them at all times.
• Review the service's protocols for completion of dental care records taking into account guidance provided by the Faculty of General Dental Service regarding clinical examinations and record keeping.
• Review the processes and systems in place for seeking and learning from staff feedback with a view to monitoring and improving the quality of the service.

We carried out an announced comprehensive inspection on 7 June 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

Smile orthodontics Yorkshire is situated in Scarborough, North Yorkshire and is a partnership. The treatments, both NHS and private include fixed aesthetic braces. The service is provided by three Orthodontist specialists who are supported by, six dental nurses and a practice co-ordinator. The practice is located on the ground floor of a shared building and there are two surgeries, a reception area, a waiting room, a decontamination room, a separate room for the Orthopantomogram (OPT) machine (an OPT machine is a panoramic scanning dental X-ray of the upper and lower jaw) and a patient toilet. The practice is located close to local amenities and bus services.

The practice is open:

Monday – Friday 09:00 – 13:00 & 14:00 – 17:00

One of the partners 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.

On the day of inspection we received feedback from one family and they were very positive about the care and treatment they received at the practice. They told us they were involved in all aspects of their care and found the staff to be very friendly, caring and they were always treated with dignity and respect.

Our key findings were:

• The practice had systems to assess and manage risks to patients, including infection prevention and control, health and safety, safeguarding, recruitment and the management of medical emergencies.
• There were sufficient numbers of suitably qualified staff to meet the needs of patients.
• The Orthodontists carried out an assessment in line with recognised guidance from the British Orthodontic Society (BOS).
• Patients received clear explanations about their proposed treatment, costs, benefits and risks and were involved in making decisions about it.
• Patients were treated with dignity and respect and confidentiality was maintained. Staff ensured there was sufficient time to explain fully the care and treatment they were providing in a way patients understood.
• There was a complaints system in place. Staff recorded complaints and cascaded learning to all staff.
• The governance systems were effective.
• The practice sought feedback from staff and patients about the services.

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

• Review the practice’s protocols for recording in the patients’ dental care records or record elsewhere the reason for taking the X-ray and quality of the X-ray; giving due regard to the Ionising Radiation (Medical Exposure) Regulations (IR(ME)R) 2000.

We spoke with two children who were patients of the service with parents present. Patients indicated that they were satisfied with the service overall. For example one patient told us "They explain everything very well. This is particularly important as this is a long term commitment and we need to understand how to work with the dentist”.

We spoke with one of the two dentists, the provider and three clinical staff. They confirmed that their priority was to give a high quality service, to listen to their patients and to continually improve.

People told us that they were given appropriate information and advice so that they could make an informed decision about their treatment.

We saw patient records which showed that each person had a comprehensive assessment of their dental health needs and a plan of treatment. Each person had been asked their consent to treatment and had signed their agreement. For children, their parents had given valid consent.

We saw that people were protected from harm, through the safe recruitment of staff, staff training and effective risk assessment.

The practice was clean and hygienic and we saw there were infection control procedures in place to ensure people were protected from the risk of infection.

The service had a system to regularly assess the quality of its service. For example, we saw there were regular checks on equipment and infection control and that the service planned audits to inform future improvement.