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Plymouth Orthodontics Limited

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Inspection report

Date of Inspection: 13, 28 February 2014
Date of Publication: 20 March 2014
Inspection Report published 20 March 2014 PDF

Before people are given any examination, care, treatment or support, they should be asked if they agree to it (outcome 2)

Meeting this standard

We checked that people who use this service

  • Where they are able, give valid consent to the examination, care, treatment and support they receive.
  • Understand and know how to change any decisions about examination, care, treatment and support that has been previously agreed.
  • Can be confident that their human rights are respected and taken into account.

How this check was done

We looked at the personal care or treatment records of people who use the service, carried out a visit on 13 February 2014 and 28 February 2014, observed how people were being cared for and checked how people were cared for at each stage of their treatment and care. We sent a questionnaire to people who use the service, talked with people who use the service, talked with carers and / or family members and talked with staff. We reviewed information given to us by the provider.

Our judgement

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. Where people did not have the capacity to consent, the provider acted in accordance with legal requirements.

Reasons for our judgement

People's views and experiences were taken into account in the way the service was provided and delivered in relation to their care. We spoke with five people receiving or accompanying relatives for treatment at the practice. They told us they found the staff were friendly and welcoming. They felt they and their relative were treated respectfully by the dentist and all the staff. People told us “the dentist is very friendly and answered all our questions" and “the dentist’s strength is he explains things well”. One parent told us that the dentist was “very good at speaking directly to [their child] and referring back to [the parent]”. This showed the dentist included and involved the child as the patient, as well as making sure parents were informed and able to contribute to the consultation too.

The people receiving treatment at the practice all confirmed they had been involved in their treatment plan. They said they had been given “lots of information” by the dentist about how to care for an appliance and what they could and could not eat whilst wearing it. They told us they were asked for their consent before any treatment was undertaken. Parents accompanying children told us they had signed a consent form to confirm they agreed with the treatment plan and for their child to receive treatment by the dentist.

The dentist confirmed that parents accompanying children signed a consent form to confirm they agreed with the treatment plan and for their child to receive treatment by the dentist. We saw signed consent forms for treatment on patients' records including the NHS consent form if the patient was receiving NHS care and treatment. The dentist also showed us examples of full orthodontic assessments on patient records that he explained were taken at the first appointment for each patient. This was an electronic record. If any significant change for treatment occurred, the dentist added additional notes to the plan. He showed us how he recorded all the options he had discussed with the patient (and parent if appropriate).

We asked the dentist how they sought informed consent from their patients for treatment. They told us they would talk through all the options of treatment and the benefits and risks of each option. The dentist said they included waiting a period of time before considering treatment as an option however they explained to the patient what may happen if the treatment was not carried out. The dentist said that treatment was only given when it was considered to be safe and appropriate for the individual and the dentist was confident the person was capable of making the decision for treatment. The dentist told us they were very conscious about risk and therefore ensured they had gained full patient consent before proceeding with any treatment. They told us that if people were self-referrals, they would discuss if treatment was appropriate, suitable and needed. The dentist also said they would always seek a second opinion if there were any doubts or concerns about treatment for a patient.

If they were concerned about a person's capacity to understand and make informed decisions, the dentist told us they would try to ensure that the correct people were involved in making decisions in the best interests of the patient.

The dentist told us they wrote to the patient's dentist to inform them of the proposed treatment plan. If teeth needed to be extracted before an appliance could be fitted, the general dentist would be told about this. It was also reliant on the general dentist to inform the orthodontist if there were any problems with extractions. The dentist said that whenever it was possible they tried to start treatment without the removal of any teeth however this was not always possible. If needed patients could be referred to the local hospital for extractions and the dentist was able to facilitate this.

The people we spoke with said that the dentist had given them time to think about treatment before agr