We carried out this announced inspection on 30 August 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. We did not receive any information of concern from them.

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 providing well-led care in accordance with the relevant regulations.

Background

Trinity House Orthodontics is located in Selby and provides NHS and private orthodontic treatment to adults and children.

There is a lift to access the practice for people who use wheelchairs and pushchairs. Car parking spaces are available near the practice.

The dental team includes one Specialist Orthodontist, a dentist with an interest in orthodontics, six dental nurses (one of whom is the lead dental nurse and one also works on reception), three orthodontic therapists, two receptionists and the practice manager.

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. The registered manager at Trinity House Orthodontics was the practice manager.

On the day of inspection we collected 46 CQC comment cards filled in by patients. This information gave us a positive view of the practice.

During the inspection we spoke with three dental nurses, two orthodontic therapists (one of which is the clinical lead), two receptionists and the practice manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday – Friday 8:30am – 5:30pm

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 thorough staff recruitment procedures.
• The Orthodontists carried out an assessment in line with recognised guidance from the British Orthodontic Society (BOS).
• 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.

We identified a commitment to tackling safeguarding concerns through effective leadership within the practice, staff felt empowered and were confident in their roles which had a positive impact on staff, patients and the local community.

• We found a very detailed safeguarding adults and children folder with guides and pathways of how to respond to any concerns raised or shared from patients. These included pathways for identifying physical harm, reporting neglect, reporting and supporting patients who disclose they are subject to domestic abuse, information on cyber bullying and many more. All of the pathways gave prompts specific to the concern to help guide and collate information which could be shared with any relevant external agencies.

We believe this to be notable practice which is worth sharing.

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

• Review and implement practice’s protocols, polices and registration for the use of closed circuit television cameras (CCTV) taking into account guidelines published by the Information Commissioner's Office (ICO).
• Review and implement a practice’s sharps risk assessment and ensure the practice is in compliance with the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.