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Cheltenham Orthodontics Limited

Inspection Summary


Overall summary & rating

Updated 29 January 2018

We carried out this announced inspection on 20 November 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 advisor and a newly recruited specialist dental advisor who was shadowing the inspection.

We told the NHS England area team and Healthwatch that we were inspecting the practice. They did not provide any information.

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

Are services effective?

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

Are services caring?

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

Are services responsive?

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

Are services well-led?

We found this practice was providing well-led care in accordance with the relevant regulations.

Background

Cheltenham Orthodontics Limited is situated in a two storey modernised building set on the outskirts of Cheltenham. The practice has its own car park. There is a bus stop near the practice. The practice provides mainly NHS orthodontic treatment to patients of all ages. A small number of private treatments are also provided.

There is level access for people who use wheelchairs and pushchairs from the car park into the ground floor reception area and waiting room. All facilities in the building are accessible for people with a disability.

The dental team includes two orthodontists, two trained dental nurses, two receptionists and a practice manager The practice has two treatment rooms.

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 Cheltenham Orthodontics Limited was the principal dentist.

On the day of inspection we collected 48 CQC comment cards filled in by patients and spoke with one other patient. This information gave us a positive view of the practice.

During the inspection we spoke with orthodontists, the two dental nurses, the practice manager and both receptionists. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

·Monday- Friday 08.30am – 5.00pm

·Out of hour’s information displayed on website and via telephone answering service.

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 staff recruitment procedures which reflected the regulatory requirements.
  • 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 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.
  • Patients had their treatment peer assessed and rated using the orthodontic peer assessment rating (PAR) index.

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

  • Review the storage of dental care products and medicines requiring refrigeration to ensure they are stored in line with the manufacturer’s guidance and the fridge temperature is monitored and recorded.
Inspection areas

Safe

No action required

Updated 29 January 2018

We found 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. The practice had a very stable staff team and little recruitment had been undertaken for some years.

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

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

Effective

No action required

Updated 29 January 2018

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

The practice specialised in orthodontic treatment for straightening teeth. Patients received an assessment of their dental needs including recording and assessing their medical history. Explanations were given to patients in a way they understood and risks, benefits, options and costs were fully explained and patient consent taken. The practice kept detailed dental records of oral health assessments; treatment carried out and they monitored outcomes of treatment.

The treatment provided for patients was effective, evidence based and focussed on the needs of the individual. National Institute for Health and Care Excellence (NICE), British Orthodontic Society’s guidance, Department of Health, national best practice and clinical guidelines were considered in the delivery of orthodontic care and treatment for patients.

Patients had their treatment peer assessed and rated using the orthodontic peer assessment rating (PAR) index. All orthodontists were trained in using the PAR index. This practice quality assured all their patients treatment using the PAR index.

The staff were appropriately trained in delivering the specialised services they provided. Staff were registered with the General Dental Council and were meeting the requirements of their professional registration.

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 29 January 2018

We found this practice was providing caring services in accordance with

the relevant regulations.

We received feedback about the practice from 49 people. Patients were positive about all aspects of the service the practice provided. They told us staff were fantastic, informative and approachable. They said they were given excellent advice and had never been hurried and said their dentist listened to them. Patients commented staff made them feel at ease, especially when they were anxious about visiting the dentist.

We saw 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 29 January 2018

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

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

Staff considered patients’ different needs. This included providing facilities for families with children and level access to the practice. The practice had access to telephone interpreter services and had arrangements to help patients with sight loss. There was no hearing loop for patients with 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 29 January 2018

We found 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 although the frequency of monitoring infection control should be reviewed. This included asking for and listening to the views of patients and staff.