We carried out an announced comprehensive inspection on 30September 2015 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

Harley Street Orthodontists is part of a group of five dental practices providing orthodontic treatment (orthodontics is a branch of dentistry that involves the treatment of maligned teeth and jaws). The services are provided on a private basis only and caters for both adults and children. The split between adults and children receiving orthodontic treatment was around 80% and 20% respectively.

The practice is situated in a converted residential property. There is one large dental treatment room that contained two dental treatment delivery units which were separated by glass partitions. The practice has a separate decontamination room for cleaning, sterilising and packing dental instruments and a reception and waiting area. The facilities are on the first floor with a lift enabling disabled access.

The practice has four dentists who are specialists in orthodontic treatment and who all work on a part time basis. A dental nurse provides chair side assistance to the orthodontic specialists; on the day of our inspection a nurse from another of provider’s clinic was covering the regular nurse’s duties. Supporting the clinical staff are a practice manager, who also manages the other practices in the group, and a receptionist. The practice’s opening hours are 9.00am to 5.00pm Mondays to Thursdays.

The Principal Dentist is the registered manager. A registered manager is a person who is registered with the Care Quality Commission 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.

Before the inspection we sent Care Quality Commission comment cards to the practice for patients to complete to tell us about their experience of the practice. We collected eight completed cards and spoke to two patients. These provided a mostly positive view of the services the practice provides. All of the patients commented that the quality of care was very good.

We carried out an announced comprehensive inspection on 30 September 2015 as part of our planned inspection of all dental practices. The inspection took place over one day and was carried out by a lead inspector and a dental specialist adviser.

Our key findings were:

• Staff had been trained to handle emergencies and appropriate medicines and life-saving equipment was readily available in accordance with current guidelines.
• Patients’ needs were assessed and care was planned and delivered in line with current professional guidelines with respect to orthodontics.
• All equipment used in the practice was well maintained in accordance with the manufacturer’s instructions.
• The practice was visibly clean and well maintained.
• Infection control procedures were robust and the practice followed published guidance.
• The practice had enough staff to deliver the service.
• Staff had received training appropriate to their roles and were supported in their continued professional development (CPD)
• Staff felt well supported by the practice manager and registered manager and were committed to providing a quality service to their patients.
• Information from eight completed CQC comment cards gave us a mainly positive picture of a friendly, professional, and caring service.

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

• Consider adding oxygen to the existing emergency check list to prevent oversight of the oxygen capacity and expiry date and hydrostatic testing interval.
• Arrange for staff to receive update training in fire safety.
• Review recruitment procedures to ensure all appropriate records are kept including identity checks and both written and verbal references sought prior to appointment.
• Review the practice’s protocols for recording in the patients’ dental care records or elsewhere the reason for taking the X-ray and quality of the X-ray, giving due regard to the Ionising Radiation (Medical Exposure) Regulations (IRMER) 2000.
• Consider implementing a formal staff appraisal system.
• Arrange for all practice policies and procedures to be dated to identify when they were reviewed and updated.