We carried out this announced inspection on 23 May 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 advisor and a newly recruited specialist dental advisor who was shadowing the inspection.

We told the NHS England area team and Healthwatch that we were inspecting the practice. They did not provide any information.

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 this practice was providing safe care in accordance with the relevant regulations.

Are services effective?

We found this practice was providing effective care in accordance with the relevant regulations.

Are services caring?

We found this practice was providing caring services in accordance with the relevant regulations.

Are services responsive?

We found this practice was providing responsive care in accordance with the relevant regulations.

Are services well-led?

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

Background

The Orthodontic Practice and Consulting Rooms is situated in a four storey Regency town house set in the heart of Cheltenham. The practice has its own car park and there is free parking on several adjacent side roads. There is a bus stop directly outside the practice. The practice provides mainly NHS orthodontic treatment to patients of all ages. A small number of private treatments are also provided.

There is level access for people who use wheelchairs and pushchairs from the pavement into the ground floor reception area and waiting room. All facilities in the building are accessible for people with a disability.

The dental team includes two orthodontists, two trained dental nurses and one trainee dental nurse who also undertook receptionist duties, a secretary and one receptionist. The practice has three treatment rooms.

The practice is owned by an individual who is the principal 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 50 CQC comment cards filled in by patients and spoke with three other patients. This information gave us a positive view of the practice.

During the inspection we spoke with orthodontists, the two dental nurses, the secretary and the receptionist. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open: Monday and Wednesday 8.30am - 5.00pm; Tuesday and Thursday 8.30am – 4.00pm. The practice is closed on Friday and at weekends. There were arrangements in place for access to emergency treatment if required.

Our key findings were:

• The practice was clean and well maintained.
• The practice had infection control procedures which reflected published guidance.
• 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 staff recruitment procedures which did not fully reflect the regulatory requirements.
• 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.
• Patients had their treatment peer assessed and rated using the orthodontic peer assessment rating (PAR) index.

There were areas where the provider could make improvements and SHOULD:

• Review the practice infection control procedures and protocols to take 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 the suitability of the equipment and the premises used for providing care or treatment to a patient and ensure they were safe for such use and used in a safe way.
• Review the practice 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. The practice should also ensure, where appropriate, audits have documented learning points and the resulting improvements can be demonstrated.
• Review the practice recruitment policy and procedures to ensure accurate, complete and detailed records are maintained for all staff.

Dr Whitehead did not have people in for appointments on the day of our visit so we contacted them by telephone.

One person’s relative told us that their child had a positive experience and was fine after treatment. They said that the child had attended to have a brace fitted and would be returning for re-adjustment.

Another parent told us about their child’s experience at the practice. They said that the child’s teeth “are looking good”, that Doctor Whitehead explains treatment to the child and “speaks to them as a person and not a child”. The parent said they and their child had spoken recently about how “everything about the practice was so nice”. The person referred to how their child found attending appointments a “pleasant experience” and how they felt the reception staff were polite. They said they always arrived on time for appointments and were seen promptly.

We spoke with a young person about their experience. They told us they were pleased how their teeth were becoming “straight”. They referred to Dr Whitehead as “helpful and friendly” and how they were made to feel relaxed. They said the treatments were explained to them, the reception staff were “helpful and friendly” and how they felt the practice “was really clean”.