We carried out an announced comprehensive inspection on 5 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

Teethinline – Newport Pagnell is an orthodontic referral practice located in the centre of Newport Pagnell it offers NHS and private orthodontic treatments to adults and children. The practice share premises, staff and policies with a general dental service Newport Pagnell Dental Clinic.

The service is located on the ground floor of a commercial building, with reception, three treatment rooms and the main waiting room, separated from a further two treatment rooms and a waiting room, by a hall way that provides access to a separate business within the same building. Across the two services; four general dentists, three orthodontists, a hygienist and an orthodontist therapist work with support of 12 dental nurses, three treatment coordinators and six administration and reception staff.

The principal orthodontist 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.

25 people provided feedback about the service. We looked at comment cards patients had completed prior to the inspection and we also spoke with patients on the day of the inspection. Feedback was overwhelmingly positive about the service.

Our key findings were:

• There was appropriate equipment for staff to undertake their duties, and equipment was well maintained.

• The provider had emergency medicines in line with the British National Formulary (BNF) guidance for medical emergencies in dental practice.

• The practice made excellent use of dental nurses with extended competencies, supporting them in their training, and encouraging them to further their careers.

• Governance arrangements were in place for the smooth running of the practice.

• Patient feedback indicated that patients were treated with kindness, dignity and respect.

• Staff recruitment checks had been carried out in accordance with schedule three of the Health and Social Care Act 2008. Disclosure and barring service checks had been carried out on all staff to ensure the practice employed fit and proper persons.

• The practice carried out weekly treatment session inspections, where all aspects of the clinical work was observed and feedback given to the clinicians.

• The practice used an outside company which contacts patients after appointments by way of a text message or e-mail and invites a comment about the service.

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

• Review availability of equipment to manage medical emergencies giving due regard to guidelines issued by the Resuscitation Council (UK), and the General Dental Council (GDC) standards for the dental team.

• Review the frequency of obtaining a written medical history to reduce the risk of changes being missed that may impact on treatment.

• Review the practice’s audit processes and document learning so that resulting improvements can be demonstrated.

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

We spoke with three people and their guardians about the service and they all provided positive feedback. One person told us that they felt their orthodontist always explained what they were doing and why. We observed four appointments with people's consent and found that the people were involved and informed about their treatment.

We found that people were provided with information about their treatment and were treated with dignity and respect. We found that people were involved with their treatment planning and the service had appropriate arrangements in place to deal with foreseeable medical emergencies. We found that cleanliness and infection control procedures were in place and staff received professional development. We found that the service reacted to feedback provided by people who used the service and carried out their own checks on the quality of the service it provided.