We carried out an announced comprehensive inspection on 27 September 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

The Orthodontic Centre is part of the IDH group and is located in central Doncaster. It provides specialist NHS and private orthodontic care to children and adults. It consists of a team of Specialist Orthodontists supported by orthodontic therapists a dental hygienist and orthodontic dental nurses. The practice is visited by an implantologist twice a month.

The practice has a large reception and waiting area on the ground floor, staff changing facilities, an office, a private treatment planning room and a small kitchen. There are two surgeries on the first floor, one of which has six dental chairs, two further offices, a decontamination and sterilisation room and a separate room for the Orthopantomogram (OPG) machine (an OPG machine produces a panoramic scanning dental X-ray of the upper and lower jaw). On the second floor there is a three chair surgery and a large staff area with kitchen facilities.

There are two specialist Orthodontists, three orthodontic therapists, one dental hygienist, 18 dental nurses, a decontamination assistant, a lead receptionist, a treatment co-ordinator and a practice manager. The regional regulatory officer was also present during the inspection.

The practice is open between the hours of 8:15am and 7:30pm; opening and closing hours varying from day to day throughout the week.

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.

On the day of inspection we received 40 CQC comment cards providing feedback and we spoke with two patients. The patients who provided feedback were very positive about the care and attention to 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 pleasant and helpful, the practice had a happy and safe environment; staff were friendly and communicated well. Patients commented they were treated with dignity and respect in a clean and tidy environment.

Our key findings were:

• The practice had systems in place to assess and manage risks to patients and staff including infection prevention and control, health and safety and the management of medical emergencies.
• The practice was visibly clean and uncluttered.
• Staff had received safeguarding training, knew how to recognise signs of abuse and how to report it. They had very good systems in place to work closely and share information with the local safeguarding team.
• There were sufficient numbers of suitably qualified staff to meet the needs of patients.
• Infection control procedures were in accordance with the published guidelines.
• Oral health advice and treatment were provided in-line with the ‘Delivering Better Oral Health’ toolkit (DBOH).
• The Orthodontist carried out an assessment in line with recognised guidance from the British Orthodontic Society (BOS).
• Orthodontic treatment was well planned and provided in line with current guidelines.
• 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.
• The appointment system met patients’ needs.
• The practice was well-led and staff felt involved and supported and worked well as a team.
• The governance systems were effective and embedded.
• The practice sought feedback from staff and patients about the services they provided.

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

• Review the staff’s awareness of the use of medical emergency oxygen.
• Review the staff’s awareness on the Mental Capacity Act 2005, Gillick competence and Caldicott principles.
• Review the practices record keeping procedures to bring them in line with British Orthodontic Society (BOS) guidelines.
• Review the practices procedures for the recording and the justification of radiographic requirements to bring them in line with the National Radiological Protection Board (NRPB) guidelines.

People who used the service understood the care and treatment choices available to them. We spoke with four young people who were attending for treatment and two of their relatives. They told us they had received sufficient information about their treatment plan in a way they were able to understand. They said they had been informed of the risks, benefits and alternative options and were given time to ask questions.

People we spoke with were complimentary about the standard of care they had received. One person said, "It's good, I'm satisfied with everything." Another person told us, "Happy with everything, great service."

People were protected from the risk of infection because appropriate guidance had been followed. They were cared for in a clean, hygienic environment. People we spoke with confirmed the surgeries were well maintained and clean. They said they saw staff wearing protective equipment and washing their hands.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. Staff had completed a range of role specific training in order to maintain their registration with the General Dental Council.

The provider had an effective system to regularly assess and monitor the quality of service that people received. There was evidence that learning from incidents and investigations took place and appropriate changes were implemented. The provider took account of complaints and comments to improve the service.