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Inspection Summary


Overall summary & rating

Updated 10 August 2017

We carried out this announced inspection on 26 July 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

Roberts-Harry Clinic Ltd is in Harrogate and provides NHS specialist orthodontic services and private treatment to adults and children.

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

The dental team includes four orthodontic specialists, one periodontal specialist, four dentists (two with specialist interests in orthodontics), one dental implant dentist, 12 dental nurses (three of which are trainees), three dental hygiene therapists, six orthodontic therapists, three sterilisation assistants, six receptionists, a practice administration team and a practice manager.

The practice has seven surgeries, three are open plan to deliver orthodontic treatments, a dedicated room for taking Orthopantomogram (OPG), cone beam computed tomography (CBCT) scans and X-rays, a decontamination room for sterilising dental instruments, two treatment co-ordinator rooms, a laboratory, a staff room/kitchen and general offices.

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 Roberts-Harry Clinic Ltd was the revenue manager and this was due to be transferred over to the practice manager.

On the day of inspection we collected 32 CQC comment cards filled in by patients. This information gave us a positive view of the practice.

During the inspection we spoke with two specialist orthodontists, one perodontal specialist, two dental nurses, one dental hygiene therapist, two orthodontic therapists, the practice manager and an orthodontic project manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday – Thursday 8am – 7pm

Friday 8am – 4:30pm

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 clinical staff provided patients’ care and treatment in line with current guidelines.
  • The specialist 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.

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

  • Review the need for an updated Legionella risk assessment.
  • Review the practice’s protocols for the use of closed circuit television cameras (CCTV) taking into account guidelines published by the Information Commissioner's Office (ICO).

Inspection areas

Safe

No action required

Updated 10 August 2017

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

The practice had systems and processes to provide safe care and treatment. They used learning from incidents and complaints to help them improve.

Staff received training in safeguarding and knew how to recognise the signs of abuse and how to report concerns.

Staff were qualified for their roles and the practice completed essential recruitment checks.

Premises and equipment were clean and properly maintained. The practice followed national guidance for cleaning, sterilising and storing dental instruments.

The practice had recently been renovated and required a new legionella risk assessment.

The practice had suitable arrangements for dealing with medical and other emergencies.

Effective

No action required

Updated 10 August 2017

We found that this practice was providing effective care in accordance with

the relevant regulations.

The dentists assessed patients’ needs and provided care and treatment in line with recognised guidance. Patients described the treatment they received as professional, informative and very friendly. The clinical team discussed treatment with patients in detail so they could give informed consent and recorded this in their records.

The practice had clear arrangements when patients needed to be referred to other dental or health care professionals.

The practice supported staff to complete training relevant to their roles and had systems to help them monitor this.

Caring

No action required

Updated 10 August 2017

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

We received feedback about the practice from 32 people. Patients were positive about all aspects of the service the practice provided. They told us staff were welcoming, amazing and always had time to spend with everyone. They said that they were given helpful, honest and detailed explanations about dental treatment, and said their clinical team listened to them. Patients commented that they made them feel at ease, especially when they were anxious about visiting the practice.

CCTV was in operation within the practice and we were told there were no policies in place for its justification and safe use. There was no supporting evidence to show the practice had registered the CCTV with the ICO.

We saw that staff protected patients’ privacy and were aware of the importance of confidentiality. Patients said staff treated them with dignity and respect.

Responsive

No action required

Updated 10 August 2017

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

The practice’s appointment system was efficient and met patients’ needs. Patients could get an appointment quickly if in pain.

Staff considered patients’ different needs. This included providing facilities for disabled patients and families with children. The practice had access to telephone or face to face interpreter services and had arrangements to help patients with sight or hearing loss.

The practice took patients views seriously. They valued compliments from patients and responded to concerns and complaints quickly and constructively.

Well-led

No action required

Updated 10 August 2017

We found that this practice was providing well-led care in accordance with

the relevant regulations.

The practice had arrangements to ensure the smooth running of the service. These included systems for the practice team to discuss the quality and safety of the care and treatment provided. There was a clearly defined management structure and staff felt supported and appreciated.

The practice team kept complete patient dental care records which were, clearly written or typed and stored securely.

The practice monitored clinical and non-clinical areas of their work to help them improve and learn. This included asking for and listening to the views of patients and staff.