Archived: Broomfield Orthodontic Clinic

Updated 14 February 2017

The inspection was carried out on 2 December 2016 and was led by a CQC inspector. The inspection team also included a dental specialist advisor.

The methods that were used to collect information at the inspection included interviewing staff, observations and reviewing documents.

During the inspection we spoke with one dentist, the dental nurse, the receptionist and three patients. We reviewed policies, procedures and other records relating to the management of the service.

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 therefore formed the framework for the areas we looked at during the inspection.

Updated 14 February 2017

We carried out an announced comprehensive inspection on 2 December 2016 to ask the practice the following key questions; Are services safe, effective, caring, responsive and well-led?

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

The practice is located within a purpose adapted residential dwelling in the village of Broomfield, Chelmsford, Essex and offers predominantly NHS orthodontic treatments (dental treatment which involves the improvement of the appearance and position of mal-aligned teeth) by referral only.

The practice is open between 9am to 5pm on Mondays to Fridays.

Two specialist orthodontists, one dental nurse and a receptionist work in the practice.

The practice is registered with the Care Quality Commission (CQC) as an individual. The principal dentist is the ‘registered person’. Registered persons 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 practice has one treatment room, a combined waiting room and a reception area. Decontamination takes place in a dedicated decontamination room (Decontamination is the process by which dirty and contaminated instruments are bought from the treatment room, washed, inspected, sterilised and sealed in pouches ready for use again).

We received feedback from 47 patients who completed CQC comment cards prior to our inspection visit. Patients made very positive comments about the care and treatment that they received. They also told us that the premises were always clean, that staff were friendly and helpful. Patients said that staff explained treatment plans to them in a way that they could easily understand and they were able to be involved in making decisions about their dental care and treatment.

Our key findings were:

• The practice had systems in place for investigating and learning from complaints, safety incidents and accidents. Staff were aware of their responsibilities to report incidents.
• The practice was visibly clean and clutter free. Infection control practices were reviewed and audited to test their effectiveness.
• There were systems in place to help keep people safe, including safeguarding vulnerable children and adults. Staff had undertaken training and were aware of their roles and responsibilities in relation to this.
• Risks to the health, welfare and safety of patients and staff were regularly assessed and managed. These included risks in relation to fire, legionella and risks associated with premises and equipment. However the practice had limited information available in relation to the Control of Substance Hazardous to Health (COSHH), the potential risks and how to manage and minimise these.
• The practice had the recommended medicines and equipment for use in the event of a medical emergency and staff were trained in their use. Records were maintained in respect of the checks carried out for these medicines and equipment.
• The practice reviewed and followed guidance in relation to orthodontic dentistry. Staff undertook specific training around orthodontics.
• The dentist told us that oral assessments were carried out in line with current guidance. However details of these examinations were not routinely recorded within the patient’s dental treatment record.
• Staff were supported, supervised and undertook training in respect of their roles and responsibilities within the practice. However staff had not undertaken training in areas such the Mental Capacity Act 2005 and equality and diversity issues.
• Patients reported that they were treated with respect and that staff were polite and helpful.
• Patients were involved in making decisions about their care and treatments.
• Effective governance arrangements were in place for the smooth running of the service.
• Audits and reviews were carried out to monitor and improve services. Learning from audits and reviews was shared with relevant staff and action plans were developed to secure improvements where these were identified.
• Patient’s views were sought and these were used to make improvements to the service where these were identified.

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

• Review their responsibilities as regards to the Control of Substance Hazardous to Health (COSHH) Regulations 2002 and, ensure all documentation is up to date and staff understand how to minimise risks associated with the use of and handling of these substances.
• Review the practice's protocols for completion of dental records giving due regard to guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping so that they include a record of the dental and oral examinations carried out.
• Review the protocols and procedures to ensure staff are up to date with training in areas including information governance, the Mental Capacity Act 2005 and equality and diversity issues.