We carried out this announced inspection on 29 November 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 Care Quality Commission (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

Angle House Orthodontics Islington is in the London Borough of Islington and provides NHS and private treatment to patients of all ages.

There is level access available for people who use wheelchairs, and those with pushchairs. The practice has two treatment rooms, both located on the ground floor of the premises.

The dental team includes two orthodontists, an orthodontic therapist (who also undertakes administrative duties), three qualified dental nurses, and a trainee dental nurse. The clinical team is supported by a practice manager who also holds the role of lead dental nurse, receptionist and treatment coordinator.

The practice is owned by an organisation, 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 Angle House Orthodontics Islington was the principal dentist.

On the day of inspection, we obtained feedback from 35 patients.

During the inspection we spoke with an orthodontist, two dental nurses and the practice manager. We checked practice policies and procedures and other records about how the service is managed.

The practice is open at the following times:

• Mondays, Tuesdays and Wednesdays: 9am to 6pm
• Thursdays 10am to 7pm
• Fridays 9am to 5pm

The practice is closed for lunch between 2 and 3pm.

Our key findings were:

• The practice had effective leadership and a culture of continuous improvement.
• The practice appeared clean and well maintained.
• The practice 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.
• 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.
• 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.

The provider was proactive and dedicated to improving outcomes for young people and women in their local areas. They had engaged with local schools and homeless shelters to improve oral health outcomes in the community. We saw examples of notable practice as follows:

• The provider had launched a seven-month leadership programme in 2017 to empower young women aged 16 to 25 years from underprivileged backgrounds. This was designed to:

• Give women the confidence and skills to pursue passions, further education and training, a profession, and entrepreneurship.
• Inspire young women by providing female role models and mentors to access opportunities within various professions including law, academia, medicine, business and marketing.
• Give young women safe platform to discuss issues they face in work and life.
• Empower young women to believe they can achieve anything and challenge limitations they may face in the workplace.

The programme, for which participants took part in a graduation ceremony, provided master classes, workshops, personal development plans, internships and mentorships with professionals from various industries. The workshops and classes included topics on time management, networking, public speaking, communication, entrepreneurship, goal-setting and reflection. The programme resulted in positive outcomes including helping four young women secure university places for their chosen course of study.

All participants reported positively that they had improved in their relationship management, negotiating, time management, team working, communication, patience, self-reflection, decision making, and active listening skills. Professionals involved reported feeling more supportive and having a greater understanding of women and their personal journeys.

• The provider had established the Angle House Orthodontic Foundation in 2013; a charitable organisation chaired by the principal dentist. The charity was founded by the provider’s partners and had engaged over 1313 young people in London since its inception. The foundation had a vision of giving back to community & support causes directly helping children in areas local to their practices. They held ‘insight days’ which gave young people opportunities to gain work experience in a range of organisations.

• At the time of this inspection the foundation had made charitable donations exceeding £173,710 since 2013. These donations had contributed to the Grenfell tower appeal, local primary schools, football clubs, children’s hospices, a dyslexia foundation, and a teenage cancer charity.
• The practice was proactive at supporting the development and progression of their staff They had been running an apprentice programme since the last six years. A member of staff who commenced employment with the provider as an apprentice trainee dental nurse told us the provider had supported them to develop their skills; at the time of the inspection they held the role of practice manager, treatment coordinator and lead dental nurse. Another member of staff who began working for the provider as a dental nurse progressed to become a practice manager, and had been supported in their progression to their role as an orthodontic therapist. Staff we spoke with gave positive feedback about the support they had received.
• The practice had received accreditation for achieving high standards of environmental management with regard to reducing waste, improving efficiency, providing assurance that their environmental impact is being measured, and improving their overall environmental impact, in line with the International Organisation of Standardisation’s standards (ISO) 9001 and 14001 systems for quality management.