We carried out this announced inspection on 05 September 2018 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 End Orthodontics provides private orthodontic treatment to patients of all ages.

There is level access for people who use wheelchairs and those with pushchairs. The practice had nearby parking facilities.

The dental team includes two dentists, two dental nurses, one receptionist and one practice manager. The practice has one treatment room.

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 practice manager was the registered manager.

We received feedback about the service from 10 patients.

During the inspection we spoke with a dentist, a dental nurse, a receptionist 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 to Friday 8.30am - 6..00pm

Our key findings were:

• The practice appeared clean and well maintained.
• The practice had infection control procedures which reflected published guidance, however some improvements were required.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available, but there were some gaps in the equipment maintained.
• The practice had systems to help them manage risk.
• The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• The practice 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.
• The practice was providing preventive care and supporting patients to ensure better oral health.
• The appointment system met patients’ needs.
• The practice had effective leadership and a culture of continuous improvement.
• Staff felt involved and supported and worked well as a team.
• The practice asked staff and patients for feedback about the services they provided.
• The practice dealt with complaints positively and efficiently.
• The practice had suitable information governance arrangements.

There were areas where the provider could make improvements. They should:

• Review the systems for checking and monitoring equipment taking into account current national guidance and ensure that all equipment is well maintained.
• Review availability of medicines and equipment to manage medical emergencies taking into account guidelines issued by the British National Formulary, the Resuscitation Council (UK), and the General Dental Council (GDC) standards for the dental team.
• Review the practice’s infection control procedures and protocols to take into account guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices and have regard to The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance.’

Two people who use the service told us that staff gave them adequate information about their treatment and costs. People were treated in private and with a dental nurse present. People described the staff's attitude as "professional, attentive, friendly, polite and respectful".

General orthodontic assessments were carried and diagnoses and treatment options were discussed with people. Detailed reports were written that included the treatment plan and people were given copies of these. People who use the service told us that they had "good experiences" at the practice. One person told us that they were "happy" with the care that they received and would recommend the practice to others.

The environment was clean and tidy on the day of the inspection and people who use the service told us that practice was always clean. Instruments were appropriately decontaminated and stored safely.

Staff had undertaken training including infection control, basic life support and safeguarding vulnerable adults and children. The dental nurse was appraised on her performance on an annual basis.

Satisfaction surveys were carried out on an ongoing basis at the end of people's treatment. Analysis of the latest survey found that all six respondents were extremely satisfied with the quality of care that they received. There was a procedure in place for the audit of the safety and suitability of the practice facilities.