We carried out this announced inspection on 14 January 2019 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We planned the inspection to check whether the registered provider was meeting the legal requirements in the Health and Social Care Act 2008 and associated regulations. The inspection was led by a CQC inspector who was supported by a specialist dental adviser.

To get to the heart of patients’ experiences of care and treatment, we always ask the following five questions:

• Is it safe?

• Is it effective?

• Is it caring?

• Is it responsive to people’s needs?

• Is it well-led?

These questions form the framework for the areas we look at during the inspection.

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

West Bridgford Orthodontic Centre is in Nottingham and provides NHS and private treatment to adults and children.

There is level access for people who use wheelchairs and those with pushchairs. There is roadside car parking in the area near the practice.

The dental team includes one specialist orthodontist, two orthodontist therapists, four qualified dental nurses, one trainee dental nurse, three receptionists and the practice manager. The practice has two treatment rooms which are both on the ground floor.

The practice is owned by a company and as a condition of registration must have a person registered with the Care Quality Commission as the registered manager. Registered managers have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run. The registered manager at West Bridgford Orthodontic Centre is the practice manager

On the day of inspection, we collected 18 CQC comment cards filled in by patients and spoke with two other patients.

During the inspection we spoke with one orthodontist, four dental nurses, two orthodontic therapists, two receptionists and the practice manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open: Monday and Tuesday: from 8am to 7pm, Wednesday and Thursday: from 8am to 5pm Friday: from 8am to 3pm. The practice is closed Saturday and Sunday.

Our key findings were:

• The practice appeared clean and well maintained.
• The provider had infection control procedures which reflected published guidance.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• The practice had systems to help them manage risk to patients and staff.
• The provider had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
• The provider had thorough staff recruitment procedures.
• The clinical staff provided patients’ care and treatment in line with current guidelines.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• Staff were providing preventive care and supporting patients to ensure better oral health.
• The appointment system took account of patients’ needs.
• The provider had effective leadership and culture of continuous improvement.
• Staff felt involved and supported and worked well as a team.
• The provider asked staff and patients for feedback about the services they provided.
• The provider dealt with complaints positively and efficiently.
• The provider had suitable information governance arrangements.

During our visit we spoke to three patients, the practice manager, an orthodontic therapist, a dental nurse and a reception member of staff.

Patients we spoke to were involved in their care and treatment options. Patients were happy with the care provided and thought the practice was clean and hygienic. One patient said, “I snapped my brace and they found me a slot to help deal with the problem.” Another patient said, “I feel comfortable talking to the staff here. They have all been lovely."

We observed members of staff interacting with patients in a courteous, polite and efficient manner. We also observed the orthodontic therapist who worked in the practice and saw that they provided information about how to maintain good oral hygiene and how to clean teeth when wearing a permanent brace.

We saw that the practice had implemented an infection control policy and that staff were encouraged to develop their skills and undertake appropriate training to help deliver safe and effective care to patients. One member of staff said, “An IPS (Infection Prevention Society) audit is done every six months to make sure things are being cleaned to a certain standard.”

We looked at information from patient feedback forms and other audits undertaken by the provider to assess the quality of the service. Patient feedback was generally positive and there were a number of audits undertaken by the practice to ensure an effective service was provided to patients.