We carried out an announced comprehensive inspection on 1 February 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 this practice was providing safe care in accordance with the relevant regulations.

Are services effective?

We found this practice was providing effective care in accordance with the relevant regulations.

Are services caring?

We found this practice was providing caring services in accordance with the relevant regulations.

Are services responsive?

We found this practice was providing responsive care in accordance with the relevant regulations.

Are services well-led?

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

Background

Wells Orthodontics is situated in a Victorian semi-detached house converted to an orthodontic practice in 2007.The building is in the centre of Wells. It is easily accessed from the surrounding towns and villages with ample parking close by. The practice is fully accessible to disabled patients with dedicated disabled parking and a chair lift to the first floor where all facilities can be accessed on the same level.

The practice has five surgeries which are equipped with the orthodontic technology including a digital imaging centre to help patients achieve good oral health. The practice has a modern comfortable waiting area on the ground floor where patients can see the latest advances in orthodontic treatment on a TV screen.

The practice provides specialist orthodontic care for children and adults via the NHS and privately. Orthodontics is the branch of dentistry concerned with growth and development of orofacial structures, including irregularities of teeth, malocclusion, and associated facial problems.

The practice is open: Monday and Wednesday 8.30am-5.30pm, Tuesday and Thursday 8.30am-6.30pm, and Friday 8.30am–4.30pm.The practice is closed at the weekend.

The practice is registered with the Care Quality Commission (CQC) as a limited company and has a registered manager. 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. .

We received feedback from six patients about the service. The three CQC comment cards seen and six patients spoken with reflected very positive comments about the staff and the services provided. Patients commented the practice appeared clean and tidy and they found the staff very caring, friendly and professional. They had trust and confidence in the dental treatments and said explanations from staff were clear and understandable. They told us appointments usually ran on time and they would highly recommend the practice.

Our key findings were:

• There were systems in place to help ensure the safety of staff and patients. These included safeguarding children and adults from abuse, maintaining the required standards of infection prevention and control and responding to medical emergencies.
• We observed and were told by staff the practice ethos provided patient centred dental care in a relaxed and friendly environment.
• Leadership was provided by the principal specialist orthodontist dentist and an empowered practice manager.
• Staff had been trained to handle emergencies and appropriate medicines and life-saving equipment were readily available in accordance with current guidelines.
• The orthodontic practice had effective clinical governance and risk management processes in place; including health and safety and the management of medical emergencies.
• Patient care and treatment was delivered in line with evidence-based guidelines, best practice and current legislation including National Institute for Care Excellence (NICE) guidelines.
• Patient dental records were electronic, detailed and comprehensive.
• The practice had a comprehensive system to monitor and continually improve the quality of the service; including through a detailed programme of clinical and non-clinical audits.
• The use of digital radiographs to help explain necessary treatment to patients while in the chair.
• Premises appeared well maintained and visibly clean. Good cleaning and infection control systems were in place. The treatment rooms were well organised and equipped, with good light and ventilation.
• There were systems in place to check all equipment had been serviced regularly, including the air compressor, autoclave, fire extinguishers, oxygen cylinder and the X-ray equipment.
• There were sufficient numbers of suitably qualified staff who maintained the necessary skills and competence to support the needs of patients.
• Staff were up to date with current guidelines, supported in their professional development and the practice was led by a proactive principal dentist.
• The service was aware of the needs of the local population and took these into account in how the practice was run.
• Patients could access treatment and urgent and emergency care when required with information for out of Hours service clearly available.
• Staff received training appropriate to their roles and were supported in their continuing professional development (CPD) by the company.
• Staff we spoke with felt well supported by the principal orthodontist and registered manager and were committed to providing a quality service to their patients.
• Specialist orthodontic dental care was provided in accordance with current legislation, standards and guidance.
• Patients’ care and treatment was planned and delivered in line with evidence based guidelines, best practice and current legislation within their specialist field.

• 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 their confidentiality was maintained.

• The appointment system met the needs of patients and waiting times were kept to a minimum.

• The practice took into account any comments, concerns or complaints and used these to help them improve the service provided. We observed complaints were dealt with in a timely manner.
• Common themes from the CQC comment cards were patients felt they received excellent care in a clean environment from a helpful practice team.
• Orthodontists, therapists and dental nurses all had specialist skills supported by enhanced skills training. They worked well as a team supporting each other and were able to undertake extended roles such as in radiography and taking impressions
• The practice had a dental/orthodontic laboratory on site for making and mending appliances which enabled a quick response to patient requirements.
• The role of a patient coordinator to ensure patients fully understood their treatment options.
• Patients had their treatment peer assessed and rated using the orthodontic peer assessment rating (PAR) index.

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

• Review the process for updating the Control of Substances Hazardous to Health (COSHH) file.

• Review the practice 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 with particular attention to the Annual Infection Control statement.

• Review the Legionella risk assessment and implement actions required including staff access to training about legionella awareness.