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Inspection carried out on 23 October 2018

During a routine inspection

We carried out this announced inspection on 23 October 2018 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

InDental Orthodontics is in Gateshead, Tyne and Wear and provides NHS and private orthodontic treatment to adults and children.

InDental Orthodontics occupies the first floor of a purpose-built premises; it’s sister practice InDental practice is on the ground floor. There is level access for people who use wheelchairs and those with pushchairs. A lift is available for patients. Car parking spaces are present near the practice.

The dental team includes a specialist orthodontist, a dentist with special interests in orthodontics, a practice manager, an orthodontic therapist, three dental nurses, two decontamination assistants and a receptionist. The practice has two treatment rooms all on the first floor.

The practice is owned by a partnership 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 InDental Orthodontics was the practice manager.

On the day of inspection, we collected 15 CQC comment cards filled in by patients.

During the inspection we spoke with a dentist with special interests in orthodontics, two dental nurses, one decontamination assistant, an orthodontic therapist, the receptionist 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, Tuesday, Wednesday and Friday 8am to 5pm

Thursday 8am to 4pm

Our key findings were:

  • The practice appeared clean and well maintained.
  • The practice had infection control procedures in place; these did not reflect published guidance in relation to temperature monitoring of manual decontamination procedures and gypsum clinical waste disposal.
  • Staff knew how to deal with medical emergencies. Appropriate medicines and life-saving equipment were available.
  • The provider had systems to help them manage risk. These systems were not always effectively monitored.
  • The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
  • The provider had staff recruitment procedures. These required reviewing, in particular for carrying out Disclosure and Barring service checks.
  • The clinical staff provided patients’ care and treatment in line with current guidelines.
  • Staff treated patients with dignity and respect and took care to protect their privacy and personal information. The practice had closed-circuit television (CCTV) on the premises. The practice’s CCTV protocols did not follow national guidance.
  • The practice provides preventive care and support to patients to ensure better oral health.
  • The appointment system met patients’ needs.
  • The practice leadership could be improved.
  • The practice had suitable information governance arrangements.
  • 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.
  • The monitoring of dental nurses’ training and development could be more robust, for example, by introducing an appraisal system.
  • Significant events and incidents were not logged.

We identified an area of notable practice.

  • The practice holds a patient forum every six months. Patients are invited to the practice one evening, are provided with refreshments and asked for five positive and five negative aspects of their experience at the dental practice. The results are then analysed and, where appropriate, changes are implemented into practice. The Department of Health invited the practice manager to events to discuss the practice forum as an exemplary to other practices. We believe this is notable because it shows the provider values patients’ opinions, welcomes compliments from patients and responds to concerns or recommendations constructively.

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

  • Review the practice’s system for recording, investigating and reviewing incidents or significant events with a view to preventing further occurrences and ensuring that improvements are made as a result.
  • Review the practice’s protocols for the use of closed-circuit television taking into account the guidelines published by the Information Commissioner's Office.

  • Review the practice’s risk management systems to ensure risk assessments are carried out for all hazardous substances identified by the Control of Substances Hazardous to Health Regulations 2002, and for all other risks identified on-site.
  • Review the practice’s infection control and waste disposal procedures and protocols taking into account the guidelines issued by the Department of Health in the Health Technical Memorandum 01-05: Decontamination in primary care dental practices.
  • Review the practice’s referral protocols to ensure all referrals are monitored appropriately.