We carried out an announced comprehensive inspection of this practice on 1 December 2015. Breaches of legal requirement were found. After the comprehensive inspection, the practice wrote to us to say what they would do to meet legal requirements in relation to clinical audits and continuous professional development.

We undertook this desk-based inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Watford Orthodontic Practice Limited on our website at www.cqc.org.uk

Our findings were:

Are services well-led?

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

Background

Watford Orthodontic Practice Limited is a solely orthodontic practice providing referral orthodontic services for NHS patients.

The practice manager has applied to become 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.

Our key findings were:

• Infection control and radiology audits were completed by the practice and action plans directed staff on areas of improvement.

• Staff were required to submit all training certificates to the practice manager who maintained oversight of the training and training needs of staff.

We carried out an unannounced comprehensive inspection on 1 December 2015 to ask the practice the following key questions; Are services safe, effective, caring, responsive and well-led? The inspection was arranged in response to concerns received through our customer service centre.

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

Watford Orthodontic Practice Limited is a solely orthodontic practice providing referral orthodontic services for NHS patients. It was taken over by a new provider on 1 April 2015, and is currently in the planning stages of a significant re-modelling of the building.

The principal orthodontist is the nominated individual of the practice, and there are in the process of changing the registered manager from the previous owner to the current practice 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.

This inspection was carried out on short notice in response to concerns raised about the practice. Therefore we were unable to send comment cards ahead of the inspection for patients to complete Feedback was obtained from patients on the day of the inspection.

Our key findings were:

• Patient feedback indicated that patients were happy with the service they had from the practice, and were always treated with dignity and respect

• The practice was maintaining accurate, legible and contemporaneous patient dental care records.

• The practice did not have access to an automated external defibrillator and both the service and expiry dates of the medical oxygen available on the premises were passed. Following the inspection this was rectified.

• The practice had some policies and protocols relating to the management of the service which had recently been reviewed.

• Some equipment had not been serviced and maintained regularly

• The practice was not carrying out the required clinical audits in infection control and X-ray quality, although this was rectified following our inspection.

• The practice had implemented a schedule of practice meetings

We identified regulations that were not being met and the provider must:

• Ensure audits of various aspects of the service, such as radiography and infection control are undertaken at regular intervals to help improve the quality of service. The practice should also check all audits have documented learning points and the resulting improvements can be demonstrated.

• Ensure staff are up to date with their mandatory training and their Continuing Professional Development (CPD)

You can see full details of the regulations not being met at the end of this report.

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 at appropriate intervals the training, learning and development needs of individual staff members and establish an effective process for the on-going assessment and supervision of all staff.

• 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.
• Maintain accurate, complete and detailed records relating to employment of staff. This includes making appropriate notes of verbal reference taken and ensuring recruitment checks, including references, are suitably obtained and recorded.
• Segregate and dispose of waste in accordance with relevant regulations giving due regard to guidance issued in the Health Technical Memorandum 07-01 (HTM 07-01).

• Review the practice’s protocols for recording in the patients’ dental care records or 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.

• Establish whether the practice is in compliance with its legal obligations under Ionising Radiation Regulations (IRR) 99 and Ionising Radiation (Medical Exposure) Regulation (IR(ME)R) 2000.