When we inspected the service in February 2013 we had concerns about the arrangements for cleanliness and infection control. Most of the those concerns were due to the maintenance, design and layout of the premises. We also had concerns about the practice's arrangements for the recording, safekeeping and disposal of medicines, and the effectiveness of some of the practice's procedures for carrying out audits and checks. We required the provider to make improvements in those areas.

In our follow-up inspection we found that the provider had implemented improvements that had brought about a transformation of the service. The provider had also made structural changes to the premises that had transformed the premises into a much improved environment. The surgical equipment decontamination room had been significantly improved as had storage areas and staff facilities.

We spoke with two patients and a relative. The patients told us that they understood the treatment proposed and received and that the orthodontist had explained the risks and benefits of the treatment. Each time they attended an appointment they had been asked about any changes in their general health. A patient told us that the treatment room was always clean and tidy when they attended the service. A patient and their relative told us that they were "very happy with the service."

The waiting room was small and could accommodate only five seated people. The relative told us that there had been occasions when she and the patient had to stand in the waiting room area. When we left the practice after our inspection we saw that two people had to stand.

We looked at the results of a recent survey that 100 patients had completed. The results were positive. Patients had expressed that they were very satisfied with their experience of the service. The only thing a small number of patients had been less than very satisfied with was that on occasions they had waited past their scheduled appointment time to be seen.

We found that there were lapses in the quality of record keeping in relation to audits and checks that had been carried out. Emergency equipment was not easily accessible. A paper hand towel dispenser and a hand-gel dispenser were empty. Areas of the practice accessible only to staff were untidy and required thorough cleaning.