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Inspection Summary


Overall summary & rating

Updated 28 December 2018

We carried out this announced inspection on 4 December 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

Pinnacle Orthodontics is in Coventry and provides NHS and private orthodontic treatment to patients of all ages. Orthodontics is a specialist dental service concerned with the alignment of the teeth and jaws to improve the appearance of the face, the teeth and their function. Orthodontic treatment is provided under NHS referral for children except when the problem falls below the accepted eligibility criteria for NHS treatment. Private treatment is available for these patients as well as adults who require orthodontic treatment.

There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces, including one for blue badge holders, are available in the dedicated practice car park. The practice is situated less than a five-minute walk from Coventry train station.

The dental team includes seven dentists, two dental nurses, one trainee dental nurse, two receptionists and one practice manager who is also a qualified dental nurse. The practice has three treatment rooms.

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 Pinnacle Orthodontics is the principal dentist.

On the day of inspection, we collected 29 CQC comment cards filled in by patients.

During the inspection we spoke with two dentists, one dental nurse, one 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 from 9am to 5.30pm.

Tuesday from 9am to 6pm.

Wednesday from 9am to 6pm.

Thursday from 9am to 5.30pm.

Friday from 9am to 4.30pm.

The practice offers later appointments to 8pm on alternate Wednesdays.

Our key findings were:

  • Effective leadership was provided by the principal dentist and an empowered practice manager.
  • Staff we spoke with felt well supported by the principal dentist and practice manager and were committed to providing a quality service to their patients.
  • The practice appeared clean and well maintained.
  • The provider had infection control procedures which reflected published guidance.
  • Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available with the exception of the oxygen cylinder which was smaller than recommended by the resuscitation guidelines. The correct size cylinder was ordered following our visit.
  • The practice had systems to help them manage risk to patients and staff. There was scope to strengthen the recording and monitoring of patient safety alerts.
  • The provider had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children. Several team members including the safeguarding lead were trained to level three in safeguarding. All staff were scheduled to complete level three safeguarding training in January 2019.
  • The provider had thorough staff recruitment procedures.
  • 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 took account of patients’ needs.
  • The provider asked staff and patients for feedback about the services they provided.
  • The provider dealt with complaints positively and efficiently.
  • The provider had suitable information governance arrangements.

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

  • Review the practice’s arrangements for receiving and responding to patient safety alerts, recalls and rapid response reports issued from the Medicines and Healthcare Products Regulatory Agency (MHRA) and through the Central Alerting System (CAS), as well as from other relevant bodies, such as Public Health England (PHE).
  • Review the availability of equipment in the practice to manage medical emergencies considering the guidelines issued by the Resuscitation Council (UK) and the General Dental Council.
Inspection areas

Safe

No action required

Updated 28 December 2018

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

The practice had systems and processes to provide safe care and treatment. There was scope to strengthen the recording and monitoring of patient safety alerts.

They used learning from incidents and complaints to help them improve. The practice took their responsibilities for patient safety seriously and staff were aware of the importance of identifying, investigating and learning from patient safety incidents.

Staff received training in safeguarding people and knew how to recognise the signs of abuse and how to report concerns. The practice had made two recent safeguarding referrals which they had failed to notify CQC about; their processes were immediately amended to ensure that notifications would be sent in the future. Safeguarding flow charts with local authority contact details were displayed in reception, the decontamination room and the management office.

Staff were qualified for their roles and the practice completed essential recruitment checks. There were sufficient numbers of suitably qualified staff working at the practice.

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

The practice had suitable arrangements for dealing with medical and other emergencies. Appropriate medicines and life-saving equipment were available except for the oxygen cylinder which was smaller than recommended by the resuscitation guidelines. The correct size cylinder was ordered following our visit.

Effective

No action required

Updated 28 December 2018

We found that this practice was providing effective care in accordance with

the relevant regulations.

The dentists assessed patients’ needs and provided care and treatment in line with recognised guidance. Patients described the treatment they received as very good, fantastic and professional

. The dentists 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. An online referral system was used to monitor and track outgoing referrals.

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

Staff understood the importance of obtaining informed consent and of working in accordance with relevant legislation when treating patients who might lack capacity to make decisions.

Caring

No action required

Updated 28 December 2018

We found that this practice was providing caring services in accordance with

the relevant regulations.

We received feedback about the practice from 29 people. Patients were positive about all aspects of the service the practice provided. They told us staff were very helpful, friendly and caring

.

They said that treatment was explained well and instructions given to children had been excellent and simple to follow. Patients consistently said that their dentist listened to them and helped with any queries that they had. Other comments received advised that the team helped them to feel at ease, especially when they were anxious about visiting the dentist.

We saw that staff protected patients’ privacy and were aware of the importance of confidentiality. Patients said staff treated them with dignity and respect.

During the inspection we saw staff showed a friendly and helpful attitude towards patients.

Responsive

No action required

Updated 28 December 2018

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. Following patient feedback, the practice had extended it’s opening hours to open until 6pm on Tuesdays and until 8pm on alternate Wednesdays.

The practice was aware of the needs of the local population and took those these into account in how it ran. This included providing facilities for patients with a disability and families with children. The practice had access to telephone and face to face interpreter services and had arrangements to help patients with sight or hearing loss.

The practice took patients views seriously. They valued compliments from patients and responded to concerns and complaints quickly and constructively. The practice displayed their complaints procedure in the reception area, in the patient information leaflet and on their website.

Well-led

No action required

Updated 28 December 2018

We found that this practice was providing well-led care in accordance with

the relevant regulations.

Strong and effective leadership was provided by the principal dentist and empowered practice manager. There was a clearly defined management structure and staff felt supported and appreciated. Staff told us that they could raise any concerns with the principal dentist and practice manager.

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.

The practice team kept complete patient dental care records which were, clearly typed and stored securely.

The provider monitored clinical and non-clinical areas of their work to help them improve and learn. This included asking for and listening to the views of patients and staff.