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Inspection carried out on 25 February 2020

During a routine inspection

We carried out this announced inspection on 25 February 2020 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.

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

Herts Orthodontics is a well-established practice that offers both private and NHS orthodontic treatment to adults and children. The dental team includes four orthodontists, an orthodontic therapist, 4 qualified dental nurses, one of whom is the practice manager, 1 sterilisation nurse and 1 trainee dental nurse and reception staff. There are three treatment rooms. The practice is not wheelchair accessible as it is sited on an upper floor above a GP practice. There is parking in local car parks nearby.

The practice is open on Mondays, Wednesdays and Fridays from 9am to 5pm, on Tuesdays from 8am to 5pm and on Thursdays from 9am to 6.30pm.

The practice is owned by an individual who is the principal dentist 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 45 CQC comment cards filled in by patients. We spoke with the practice manager, one orthodontist, one orthodontic therapist, two dental nurses and reception staff. We looked at practice policies and procedures and other records about how the service is managed.

Our key findings were:

  • Patients were positive about all aspects of the service the practice provided and commented positively on the treatment they received, and of the staff who delivered it.
  • Premises and equipment were clean and properly maintained and the practice followed national guidance for cleaning, sterilising and storing dental instruments.
  • The provider had systems to help them manage risk to patients and staff.
  • The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
  • Patients’ care and treatment was provided in line with current guidelines.
  • The practice had effective leadership and staff worked well as a team. Staff felt respected, supported and valued.
  • The principal dentist asked staff and patients for feedback about the services they provided
  • Waiting times were lengthy, with nearly a 20 month wait before treatment commenced.

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

  • Take action to ensure clinicians record in the patients’ dental care records or elsewhere the reason for taking X-rays, a report on the findings and the quality of the image in compliance with Ionising Radiation (Medical Exposure) Regulations 2017.

Inspection carried out on 24 July 2013

During a routine inspection

When we inspected Herts Orthodontics on 24 July 2013 we found that the provider and staff provided people with information before seeking their consent. One young person visiting the practice on the day of our inspection said, "They showed me a video and explained everything that was going to happen. They said I could have the brace taken off at any time if I wanted to.� Another young person said, �They showed me what was going to happen with a model then showed me a video. It made me feel more relaxed about it.�

People's needs were assessed and their orthodontic treatment was planned according to those needs. This included referral back to the person's primary dental care provider for further treatment where necessary

The provider was equipped to deal with medical emergencies.

The practice operated decontamination procedures in accordance with their infection control policy and Department of Health Guidance on decontamination.

Staff were supported with training and clinically qualified staff were enabled to carry out continuing professional development to maintain their professional registration. The provider carried out appraisals for staff that were relevant to their role.

The provider monitored the quality of the service by carrying out internal audits, such as a records audit, and by seeking the feedback of people through surveys.