We carried out an announced comprehensive inspection on 15 March 2017 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

Total Orthodontics is part of a group of specialist dental practice’s providing orthodontic treatment to children and adults 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 teeth and their function).

Orthodontic treatment is provided under NHS for children except when the problem falls below the accepted eligibility criteria. Private treatment is available for these patients as well as adults who require orthodontic treatment.

The practice is situated in a converted commercial property. The practice has a suite of treatment and consulting rooms and a separate decontamination room on the first floor of the building with a reception and waiting area on the ground floor.

The practice is open; Monday 8.30am – 6.30pm, Tuesday 8.30am – 5.00pm, Wednesday 8.30am – 4.30pm, Thursday 8.30am – 5.00pm, Friday 8.30am – 4.30pm, Saturday 9.00am – 1.00pm (one in four).

The practice has four orthodontists providing orthodontic care and are supported by three orthodontic therapists, four dental nurses, a practice manager, administrative staff and two receptionists.

The practice manager and the lead clinician are the registered manager’s. 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 12 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 clinical leadership was provided by the clinical lead who was supported by 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 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 provider and practice manager.

We spoke with four people, who were very complimentary about the practice. They felt that they were treated with respect and dignity. They told us that they were informed about the choices, costs, alternatives and possible outcomes of their treatment.

People told us that their treatment plans were always explained and discussed with them, including choices about treatment and costs. They told us that that the practice was always clean, and all the staff were friendly, welcoming and respectful.

We observed staff talking to people throughout our visit in a polite and respectful manner. One person told us, “All the staff seem happy”. A member of staff that we spoke with said, “We really want people to have a good experience here”.

People told us they would recommend the provider to those considering orthodontic treatment. One person told us that the provider was, “Very professional, which is why I decided to go with them”.

The provider had systems in place to assess and monitor the service and effectively deal with complaints when necessary.