We carried out an announced comprehensive inspection on 12 May 2016 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 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

Battersea Orthodontics Limited is a dental practice located in the London Borough of Wandsworth. The premises are situated on the ground floor of a high-street location. There are three treatment rooms with a dedicated decontamination area behind a partition in one of the treatment rooms. There is also an X-ray room, two offices, reception area, and patient toilets.

The practice provides NHS and private services to adults and children. The practice specialises in the provision of orthodontic treatments.

There are twelve members of staff comprising the principal orthodontist, an associate orthodontist, an associate dentist who works as an orthodontic therapist, a hygienist, five dental nurses, a business manager and two receptionists. One of the dental nurses is employed as the clinical manager.

The practice opening hours are from 9.00am to 500pm on Monday, Wednesday and Friday, and from 9.00am to 6.00pm on Tuesday and Thursdays. The practice is also open for private appointments on the first Saturday each month between 10.00am and 2.00pm.

The principal orthodontist is the registered manager. A registered manager is a person who is registered with the CQC 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.

The inspection took place over one day and was carried out by a CQC inspector and a dental specialist advisor.

Ten people provided feedback about the service. Patients were positive about the care they received from the practice. They were complimentary about the friendly and caring attitude of the dental staff.

Our key findings were:

• Patients’ needs were assessed and care was planned in line with current guidance such as from the National Institute for Health and Care Excellence (NICE).

• The practice had effective safeguarding processes in place and staff understood their responsibilities for safeguarding adults and children living in vulnerable circumstances.

• There were effective systems in place to reduce and minimise the risk and spread of infection. However, we identified some improvements that the practice should make to their infection control protocols.

• There were arrangements in place for managing medical emergencies. However, some of the equipment needed for responding to medical emergencies needing renewing or replacing at the time of the inspection.

• Staff recorded accidents. However, improvements were required as the practice needed to establish a system for recording and investigating incidents and significant events.

• Equipment, such as the air compressor, autoclave (steriliser), fire extinguishers, and X-ray equipment had all been checked for effectiveness and had been regularly serviced.

• Patients indicated that they felt they were listened to and that they received good care from a helpful and caring practice team.

• Staff maintained the necessary skills and competence to support the needs of patients.

• The practice had implemented clear procedures for managing comments, concerns or complaints.

• The provider had a clear vision for the practice and staff told us they were well supported by the management team.

• There were governance arrangements and audits to monitor and improve the quality and safety of the services. However, these could be improved through the use of a wider range of audits, for example of dental record keeping.

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

• Review and establish a system for recording, investigating and reviewing incidents or significant events with a view to preventing further occurrences and ensuring that improvements are made as a result.

• 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 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.
• Review recruitment procedures to ensure accurate, complete and detailed records are maintained for all staff.
• Review the practice’s audit protocols, such as those for reviewing the quality of dental care records, to help monitor and improve the quality of service. The practice should also check that, where appropriate, audits have documented learning points and the resulting improvements can be demonstrated.

We spoke with two people using the service during our inspection and one relative of a patient. One person told us "I was able to ask questions about my treatment". Another person told us "I was given all the information I needed". People said "I was impressed", another person said "really good" and "he's a great dentist" when referring to the care and treatment they had received.

We asked to see computerised records of people's treatment plans and saw that accurate notes of each consultation visit were recorded.

People using the service told us the clinical staff always wore gloves and masks. One person said the practice "always looks very clean". There was a dedicated infection control lead at the practice and records showed that audits had been completed regularly to help ensure and maintain good standards of hygiene.

Staff were enabled to continue their professional development by being provided with appropriate up to date guidance and training in key subjects such as infection control, medical emergencies, and information governance.