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Osborne Orthodontics / Osborne Family Dentists - North Shields

Inspection Summary


Overall summary & rating

Updated 6 June 2019

We undertook a focused inspection of Osborne Orthodontics / Osborne Family Dentists – North Shields on 30 April 2019.

This inspection was carried out to review in detail the actions taken by the registered provider to improve the quality of care and to confirm that the practice was now meeting legal requirements.

The inspection was led by a CQC inspector who was supported by a specialist dental adviser.

We undertook a comprehensive inspection of Osborne Orthodontics / Osborne Family Dentists – North Shields on 27 November 2018 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We found the registered provider was not providing safe and well-led care and was in breach of regulations 12, 17, 18 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

You can read our report of that inspection by selecting the 'all reports' link for Osborne Orthodontics / Osborne Family Dentists – North Shields on our website www.cqc.org.uk.

As part of this inspection we asked:

• Is it safe?

• Is it well-led?

When one or more of the five questions are not met we require the service to make improvements and send us an action plan. We then inspect again after a reasonable interval, focusing on the areas where improvements were required.

Our findings were:

Are services safe?

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

The provider had made improvements in relation to the regulatory breaches we found at our inspection on 27 November 2018.

Are services well-led?

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

The provider had made improvements in relation to the regulatory breach we found at our inspection on 27 November 2018.

Background

Osborne Orthodontics is in North Shields and provides NHS and private treatment to adults and children. Most of treatment provided within the practice is orthodontic although a small amount of general dentistry is also carried out. The dental practice is on the first floor of a shared building. Access to the first floor is via a staircase and this is made known to patients in the practice leaflet. Car parking spaces are available near the practice. There is one large treatment room with two dental chairs and an office area within. A decontamination and X-ray room are adjoined to the treatment room. There is a separate reception and waiting area.

The dental team consists of two principal dentists (one of whom is a specialist orthodontist), two dental nurses, a decontamination assistant, a practice manager who is also a qualified dental nurse, and two receptionists.

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 Osborne Orthodontics is one of the principal dentists.

During the inspection we spoke with one of the principal dentists, a dental nurse and the practice manager.

The practice is open for treatment between 9am and 8pm Monday to Saturday on a “by appointment only basis”.

We looked at practice policies and procedures and other records about how the service is managed.

Our key findings were:

  • The practice had more efficient leadership in place.
  • Medical emergency drugs and equipment were now available in accordance with national guidance.
  • The systems to help manage risk to patients and staff had mostly improved. The provider had not implemented all of the recommendations from their fire risk assessment.
  • The provider had improved their staff recruitment procedures. They needed to review their systems to make sure they undertook all required checks.
  • The system to monitor staff training was not robust.
  • Policies were re-written and updated where applicable.
  • The practice had closed-circuit television (CCTV) on the premises; a policy had been created. There was no data protection impact assessment in place.
  • Improvements were found in some of the practice’s audit and quality assurance processes; these were inconsistent.
  • Most issues identified during our inspection on the 30 April 2019 were addressed promptly.

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

  • Review the fire safety risk assessment and ensure that any actions required are complete and ongoing fire safety management is effective.
  • Review the practice’s protocols for ensuring that all clinical staff have adequate professional indemnity and immunity for vaccine preventable infectious diseases.
  • Review staff training to ensure that all the staff have received training, to an appropriate level, in the safeguarding of children and vulnerable adults.

Inspection areas

Safe

No action required

Updated 6 June 2019

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

The practice had improved their systems and processes to provide safe care and treatment.

Medical emergency drugs and equipment were now available in accordance with national recommendations.

Staff knew how to recognise the signs of abuse and the practice’s safeguarding policy contained sufficient contact information for adult referrals. The provider ensured that all staff had undergone safeguarding training; this was not to the appropriate level for all members of staff.

Staff were qualified for their roles. The provider completed all essential recruitment checks for a new employee. They needed to review their systems for checking professional indemnity.

The provider had reviewed most of their systems to identify and manage all risks on-site. For example, they ensured hazardous substances were risk assessed, lone workers were risk assessed for safety and new risk assessments for fire and Legionella were completed.

The provider did not complete risk assessments for a clinical employee whose immune status to Hepatitis B was unknown, nor complete all the recommended actions from the fire risk assessment.

Concerns identified during our inspection on the 30 April 2019 were addressed promptly. For example, the provider arranged for the completion of the recommendations from the fire risk assessment and carried out a risk assessment for the clinical employee whose immune status to Hepatitis B was unknown.

Effective

No action required

Updated 14 January 2019

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

The orthodontic dental professionals assessed patients’ needs and provided care and treatment in line with recognised guidance. Patients described the treatment they received as professional and excellent. The orthodontic dental professionals discussed treatment with patients so they could give informed consent and recorded this in their records.

The practice had clear arrangements when patients needed to be referred to other dental or health care professionals.

The provider supported staff to complete training relevant to their roles. The systems to help them monitor this were ineffective.

The staff were involved in quality improvement initiatives, including a “good practice scheme” and peer review, as part of its approach in providing high quality orthodontic care.

Caring

No action required

Updated 14 January 2019

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

We received feedback about the practice from 23 people. Patients were positive about the service the practice provided and commented that staff provided the best treatment possible.

They said that they were always welcomed and said their orthodontist listened to them. Patients also commented on waiting times and we saw evidence that this was being addressed.

We saw that staff protected patients’ privacy and were aware of the importance of confidentiality. Patients said staff treated them with dignity and respect. A CCTV system was in operation within the treatment room, corridor and waiting areas. Appropriate signs were displayed to notify people of this. There was no CCTV policy in place and a data protection impact assessment had not been completed in line with the General Data Protection Regulation (GDPR) requirements.

Responsive

No action required

Updated 14 January 2019

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

The practice’s appointment system took account of patients’ needs. Patients could get an appointment quickly if in pain. Patients commented waiting times were regularly more than 30 minutes, often up to one hour. The provider had recognised this and introduced a new software system which would allow waiting times to be monitored more robustly.

Staff considered patients’ different needs. This assessment was not documented. The practice was on the first floor of a shared building and there was no provision made for those in wheelchairs or with pushchairs. This was described in the practice leaflet and the provider made sure patients were offered details of an alternative practice with accessible premises. The practice had access to interpreter services. The provider had assessed the needs of those with sight and hearing problems and was considering implementing measures for these patients.

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 6 June 2019

 

We found that this practice was providing well-led care and was complying with the relevant regulations.

Improvements were made to the overall management of the service and to some of the risk management systems within the practice.

The provider had set aside protected staff time for management and administration duties and clear roles and responsibilities for all the practice team were established.

Practice policies were updated and given to staff for them to read and sign. Risk assessments were undertaken for fire, Legionella, hazardous substances. Improvements were found in the practice’s recruitment procedures.

The provider should review their governance and management systems to make sure they are robust and enable continuous improvement.

The monitoring of staff’ training and development was not robust.

The provider had not recognised and did not have an effective system to highlight their infection prevention and control and orthodontic audits were overdue.