We carried out this announced inspection on 17 August 2017 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

Ortho- 2008 is based in the town centre of Blackburn and provides private and NHS treatment for both adults and children.

Treatment rooms are situated on the ground, first and second floors but access is limited for patients with limited mobility. Alternative facilities are recommended to patients with a disability. There is off street parking and additional public car parking in the town centre. There is access to public transport near the practice.

The dental team includes a practice manager, three orthodontists, four orthodontic therapists, five dental nurses (one of whom is a trainee) and one receptionist.

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 Ortho 2008 was the practice manager.

On the day of inspection we collected 25 CQC comment cards filled in by patients. This information gave us a positive view of the practice.

During the inspection we spoke with the practice manager, one orthodontic therapist, three dental nurses and one receptionist. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday, Wednesday, Thursday and Friday 8am-4:30pm.

Tuesday 8am-6:30pm.

Our key findings were:

• The practice was clean and well maintained.
• The practice had followed infection control procedures, which reflected published guidance with the exception of the dating of sterilised instruments.
• 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.

• Prescription pads were securely held, but had been damaged by water and inadequate tracking systems were in place.

• 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 appointment system met patients’ needs.
• The practice had effective leadership. 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 provider produced a quarterly newsletter for patients containing health advice and events information and also had a strong social media presence to promote oral health to younger patients.

People told us they were generally satisfied with the care and treatment provided at Ortho 2008. They said they had been involved in their treatment plan. They had discussed their options with the Orthodontist before their treatment started and agreed to proceed with the treatment. They were told what to expect in terms of length of time it would take, what they must do to care for their brace and how often they would be expected to attend the clinic for their continuing care.

One parent said they were very pleased with the overall care and treatment provided. They said “They were really good, very helpful and gave her reassurance.” Comments were made about appointment times being very quick, but there was "different attitudes to breakages amongst the staff”. Their daughter becomes quite anxious before she attends because of this. They concluded, “Most of the staff were very pleasant with her”. The practice manager told us they have a code of conduct and practice for all the staff to follow that includes treating people with dignity and respect.

One person told us they would have liked to have been advised to make an appointment with their dentist to have their teeth cleaned following the removal of their braces. They had left some staining. The practice manager said they can do this.

People told us they could not always be sure who would provide their treatment when they attended. The practice manager told us orthodontist therapists worked different days, and the practice is a teaching practice. People can request to see the same person on their visits but this limits availability with appointments.

People we spoke to said the practice is kept clean. Nurse's uniforms were clean and they wore protective clothing such as gloves and face masks when attending to them.