We carried out this announced inspection on 12 March 2019 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 not providing well-led care in accordance with the relevant regulations.

Background

Ortho Limited t/a Cheyne Walk Orthodontics is in Northampton, a town in the East Midlands. The practice provides both NHS and private orthodontic treatments to adults and children. Orthodontics is a specialist dental service concerned with the alignment of the teeth and jaws to improve the appearance of the face, the teeth and their function. Orthodontic treatment is provided under NHS referral for children except when the problem falls below the accepted eligibility criteria for NHS treatment. Private treatment is available for these patients as well as adults who require orthodontic treatment. Services of scale and polish are offered to patients as well.

Level access is not available for people who use wheelchairs and those with pushchairs; stepped access is in place at both the front and rear of the building. The premises are situated in a listed building; the potential for extensive modifications to the building is therefore limited. Car parking spaces are available in the practice’s car park at the rear of the building.

The dental team includes two orthodontists, two qualified dentists who work as orthodontic therapists, two dental nurses, one trainee dental nurse, a complaints manager, two receptionists and a cleaner.

The practice has four treatment rooms; two are on the ground floor. There is a separate decontamination facility on site.

The practice was undergoing some general refurbishment. New slip resistant and fire-resistant floor coverings were being fitted. The installation of LED lights throughout and air conditioning systems were being placed to maintain consistent temperature throughout the year.

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.

At the time of inspection there was no registered manager in post as required as a condition of registration. A registered manager is legally responsible for the delivery of services for which the practice is registered. One of the orthodontists told us they were in the process of submitting an application to become the registered manager.

On the day of inspection, we collected 33 CQC comment cards filled in by patients.

During the inspection we spoke with two orthodontists, one nurse, the complaints manager and one receptionist. We looked at practice policies and procedures, patient feedback and other records about how the service is managed.

The practice is open: Monday, Tuesday and Wednesday from 9am to 5.30pm, Thursday from 9am to 7pm, Friday from 9am to 5pm and on some Saturdays from 9am to 4pm.

Our key findings were:

• The practice appeared clean and well maintained.
• The provider had infection control procedures which mostly reflected published guidance.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• The practice had some systems to help them manage risk to patients and staff. We found areas that required improvement. Not all risk assessments were available when requested.
• The provider had safeguarding processes; although not all staff training certificates were held on record and made readily available. Staff showed awareness of their responsibilities for safeguarding vulnerable adults and children.
• The provider had staff recruitment procedures, but evidence of satisfactory conduct in previous employment had not always been obtained when staff were recruited.
• 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 took account of patients’ needs; after school appointments were available and the practice stayed opened longer one day a week.
• Staff felt involved and supported and worked well as a team.
• The provider asked staff and patients for feedback about the services they provided.
• The provider dealt with complaints positively and efficiently. A complaints manager oversaw the process.
• Governance arrangements required strengthening. Not all risks arising from the undertaking of the regulated activities had been suitably identified and mitigated.

We identified regulations the provider was not complying with. They must:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

Full details of the regulation the provider was not meeting are at the end of this report.

We spoke with a parent and child who told us they were pleased with the orthodontic treatment that they had received at the service. They also told us that the staff had explained to them information about the risks and benefits of having orthodontic treatment and had told them how to look after their teeth following the fitting of their brace.

They also told us that the staff were pleasant and had treated them in a courteous manner and that they found the clinic a suitable environment to receive their treatment.