We carried out a focused inspection of The Cullompton Orthodontic Practice on 5 June 2018.

The inspection was led by a CQC inspector who was supported by a specialist dental adviser.

We carried out the inspection to follow up concerns we originally identified during a comprehensive inspection at this practice on 17 October 2017 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions.

At a comprehensive inspection we always ask the following five questions to get to the heart of patients’ experiences of care and treatment:

• Is it safe?
• Is it effective?
• Is it caring?
• Is it responsive to people’s needs?
• Is it well-led?

When one or more of the five questions is not met we require the service to make improvements and send us an action plan. We then inspect again after a reasonable interval, focusing on the area(s) where improvement was required.

At the previous comprehensive inspection we found the registered provider was providing safe, effective, caring and responsive care in accordance with relevant regulations. We judged the practice was not providing well-led care in accordance with Regulation 17 ‘good governance’ of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can read our report of that inspection by selecting the 'all reports' link for Gestridge Dental Practice on our website www.cqc.org.uk.

Our findings were:

Are services well-led?

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

There was an area where the provider could make improvements. They should:

• Review the practice’s audit protocols to ensure infection control audits are undertaken at regular intervals and where applicable learning points are documented and shared with all relevant staff.

We carried out this announced inspection on 17 October 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.

We told the NHS England area team and Healthwatch that we were inspecting the practice. NHS England provided us with information about the contract they hold at the practice.

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

The Cullompton Orthodontic Practice is in Cullompton and provides mainly NHS and a small amount of private treatment to patients of all ages.

There is one treatment room, on the first floor. Car parking spaces are available near the practice.

The dental team includes one orthodontist, two dental nurses/receptionists and one receptionist.

The practice is owned by an individual who is the orthodontist 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.

On the day of inspection we collected eight CQC comment cards filled in by patients and spoke with two other patients. This information gave us a positive view of the practice.

During the inspection we spoke with the orthodontist and two dental nurses/receptionists. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open: Monday 8.40am – 6pm. Tuesday 8.40am – 5pm. Wednesday 8.40am – 5pm. Thursday 8.40am – 4pm. The practice closes between 1pm – 1.30pm.

Our key findings were:

• The practice was clean.
• The practice had infection control procedures which broadly reflected published guidance.
• Staff knew how to deal with emergencies. The systems to review appropriate medicines and life-saving equipment would benefit from review.
• The practice had under-developed systems to help them manage risk.
• Staff knew their responsibilities for safeguarding adults and children.
• The practice staff described safe staff recruitment procedures but staff records were not available to view.
• 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.
• Governance arrangements require improvement to ensure that the service is well-led.
• Staff felt supported by the orthodontist.
• The practice asked staff and patients for feedback about the services they provided.
• The practice had not received any complaints.

We identified regulations the provider was not meeting. They must:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care, by ensuring that the practice is supported by up to date polices and protocols reflecting current legislation and guidance. In particular; assessment of risks associated with Legionella, fire and the Control of Substances Hazardous to Health (COSHH) and regular X-ray equipment maintenance.

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

There were areas where the provider could make improvements. They should:

• Review the current infection control protocols and waste handling protocols taking into account guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices and have regard to The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance.’
• Review staff awareness of the requirements of the Mental Capacity Act (MCA) 2005 and Gillick competencies and ensure all staff are aware of their responsibilities under the Act as it relates to their role.
• Review the practice's protocol and staff awareness of their responsibilities under the Duty of Candour to ensure compliance with The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
• Review the practice’s audit protocols to ensure audits of various aspects of the service, such as radiography and infection prevention and control are undertaken at regular intervals to help improve the quality of service. Practice should also ensure that, where appropriate, audits have documented learning points and the resulting improvements can be demonstrated.

This was our first inspection of The Cullompton Orthodontic Practice since dentistry services were required to register with the Care Quality Commission. At this inspection we checked that people using the orthodontic practice had access to examinations in private. We asked people how they were involved in their treatment planning and whether they were invited to give feedback about their experiences. We also looked at the provider’s records to ensure that people received safe and effective treatment in a clean environment. In addition we assessed the provider’s systems for ensuring the confidentiality of patient records.

We visited the practice where we met and spoke with staff and checked records. We also conducted a tour of the premises. Following the visit we contacted, with their permission, a selection of people who had attended the practice for assessment or treatment the week preceding our visit. We heard comments from eight people who had either received treatment themselves or who represented children who had received treatment at practice. People expressed high levels of satisfaction. Comments included;

• ‘I cannot fault the treatment my children have received. The orthodontist has been very kind and patient.’

• ‘The orthodontist spoke to us in a very natural way, explaining as she went along.’

• ‘The orthodontist and the practice nurse make my child and I feel safe.’

• ‘Cleanliness is of the highest standard.’

• ‘Very friendly and very helpful.’