We carried out an announced comprehensive inspection on 13 January 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

St Ives-Ortho provides mainly private dental treatment to patients and some NHS orthodontic treatment to children. The practice has about 2000 active patients and is part of the Mydentist group, who have a large number of dental practices across the UK.

The practice employs one full-time dentist, one part-time orthodontist and one part-time dental hygienist. A visiting dentist attends the practice every 6- 8 weeks to fit dental implants. They are supported by a part-time practice manager and two dental nurses. The practice opens Monday to Friday from 8am to 5 pm.

At the time of our inspection the registered manager was in the process of deregistering but a new manager had been appointed and had submitted her application to register. She had been in post for only a week. 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.

The practice has one treatment room, a decontamination room for cleaning and a very small administrative office. Overall the premises are small, with limited space for staff and patients.

We received feedback from 12 patients during the inspection process. They were overwhelmingly positive about the service offered, and made particular reference to the friendliness of the staff team and the effectiveness of their treatment.

Our key findings were:

• The practice had systems to help ensure patient safety. These included safeguarding children and adults from abuse, and responding to medical emergencies.

• The practice carried out effective infection control procedures, as described in the ‘Health Technical Memorandum 01-05 (HTM 01-05): Decontamination in primary care dental practices.’ Published by the Department of Health.
• There was enough equipment for staff to undertake their duties, and it was well maintained.
• Staff received good training for their roles and were supported in their continued professional development.

• The practice sought feedback from staff and patients and used it to improve the service provided.

• The practice did not offer extended hours opening and access to appointments with the orthodontist and hygienist were limited.

• Patients’ care and treatment was not planned and delivered in line with evidence based guidelines, best practice and current legislation. We found that vital information was missing from dental care records and the recording of the quality of x-rays was inconsistent.

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

• Review the practice's protocols for completion of dental records giving due regard to guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.

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

• Secure external clinical waste bins kept in the shared lock up to a wall.

• Implement dirty to clean zoning in the treatment room.
• Review staff awareness of the requirements of the Mental Capacity Act (MCA) 2005 so that all staff are aware of their responsibilities under the Act as it relates to their role.
• Display information about how to complain in the patient waiting area and ensure that all verbal complaints are recorded centrally for monitoring and analyses.

• Only store clinical items in the clinical fridge.