We carried out an announced comprehensive inspection of this practice on 27 April 2017. A breach of legal requirement was found. After the comprehensive inspection, the practice wrote to us to say what they would do to meet legal requirements in relation to Regulation 17 HSCA (RA) Regulations 2014 Good Governance and Regulation 19 HSCA (RA) Regulations 2014 Fit and Proper Persons Employed.

We undertook a focused inspection for Specialist Orthodontic Practice on 11 July 2017. This was to follow up on actions we asked the provider to take after our announced comprehensive inspection. During the inspection in April 2017, we identified that the provider must; ensure the practice's recruitment policy and procedures are suitable and the recruitment arrangements are in line with Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 to ensure necessary employment checks are in place for all staff and the required specified information in respect of persons employed by the practice is held. Ensure the training, learning and development needs of individual staff members are reviewed at appropriate intervals and an effective process is established for the on-going assessment and supervision of all staff. Ensure the storage of records relating to people employed and the management of regulated activities is in accordance with current legislation and guidance. Ensure the practice establishes an effective system to assess, monitor and mitigate the various risks arising from undertaking of the regulated activities.

This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Specialist Orthodontic Practice on our website at www.cqc.org.uk

Our findings were:

Are services well-led?

We found that this practice was providing well-led care in accordance with the relevant regulations.

Background

Specialist Orthodontic Practice is located in Epping and provides NHS and private orthodontic treatment to patients of all ages. There is level access for people who use wheelchairs and pushchairs. The premises are on the ground floor and first floor. The practice consists of four

treatment rooms, an X-ray room, two consultation rooms, a decontamination room and a reception area.

The practice is open on Monday, Wednesday and Thursday 8:30am – 5pm, Tuesday 8:30am – 7pm and Friday 08:30am – 1:30pm.

The dental team includes the principal dentist, two associate dentists, an orthodontic therapist, a trainee orthodontic therapist, six dental nurses one of whom is also a receptionist, a practice manager, an administrator, two receptionists, a treatment coordinator and a new patient

coordinator.

The practice is owned by an individual who is the principal dentist there. They have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run.

During the inspection we spoke with the principal dentist, practice manager and the practice administrator. We looked at practice policies and procedures and other records about how the service is managed.

Our key findings were:

• Improvements were seen in all areas where concerns had been highlighted at the comprehensive inspection.
• The practice recruitment policy, procedures and the recruitment arrangements had been reviewed. Employment checks were in place for staff and the required specified information in respect of persons employed by the practice was recorded.
• The training needs of staff had been reviewed; there was a schedule for on-going assessment and supervision in place for all staff.

• The storage of records relating to people employed and the management of regulated activities had been reviewed and systems put in place to ensure records were stored securely and in accordance with current legislation and guidance.

• The practice had put processes in place to establish a system to assess, monitor and mitigate the various risks arising from undertaking the regulated activities.

At our announced inspection on 27 April 2017, there were areas we identified where the provider could make improvements. During our focused inspection on 11 July 2017 improvements were seen in all areas where the provider could make improvements.

• The practice had reviewed its arrangements for receiving and responding to safety alerts from the Medicines and Healthcare products Regulatory Agency (MHRA) and through the Central Alerting System (CAS), as well as from other relevant bodies such as, Public Health England (PHE). The practice manager was responsible for checking alerts and a process was in place to ensure actions were taken where relevant.
• The practice had reviewed its procedures with regards to the Control of Substances Hazardous to Health (COSHH) Regulations 2002. We saw that documentation was up to date and included all potentially hazardous substances relevant to the practice. In addition the practice cleaning company had a COSHH file for staff to refer to and to ensure the risks associated with the use of and handling of these substances were minimised. All clinical staff, the practice manager and the practice administrator had undergone both COSHH and Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013 (RIDDOR) training to ensure the practice had a better understanding of the potential risks and responsibilities associated with COSHH and RIDDOR.
• All staff had completed levels one and two safeguarding training for both adults and children to ensure they are trained to an appropriate level for their role and are aware of their responsibilities.

We carried out this announced inspection on 27 April 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 not providing well-led care in accordance with the relevant regulations.

When we inspected Specialist Orthodontic Practice on 19 February 2014 we found that people were provided with information about their treatment and they were asked for their consent. One young person who was visiting the practice on the day of our inspection told us, “I had a discussion with [the treatment co-ordinator] who told me all the details and showed me all the different types of braces.”

People’s needs were assessed and orthodontic treatment was planned and delivered in line with those individual needs. People confirmed that their needs had been thoroughly assessed and told us that their experience was positive. One person said, “I found it quite comfortable. The [orthodontist] gave me clear instructions and was very gentle, making sure I was okay.”

There were effective systems in place to reduce the risk and spread of infection. Instruments were cleaned and sterilised in accordance with ‘best practice’ principles set out in the Department of Health guidance on decontamination.

Staff received appropriate professional development that was relevant to their role. This included continuing professional development for clinically qualified staff and an effective system of appraisal.

The provider took account of people's feedback to improve the service. A range of audits were carried out which helped the provider to monitor quality and identify risks.