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Inspection carried out on 1 March 2016

During a routine inspection

We carried out an announced comprehensive inspection on 1 March 2016 to ask the practice the following key questions; Are services safe, effective, caring, responsive and well-led?

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.


The practice is situated on the outskirts of Chester city centre and has a waiting/reception room, four treatment areas, a decontamination room, administrative offices and an annexe building housing a further treatment room and patient consultation and waiting areas. The practice has three dentists, three dental therapists, six qualified dental nurses, receptionists, administrator and a practice manager. The practice is a specialist dental surgery providing orthodontic treatment to both adults and children. Orthodontics is specialist dental treatment that corrects irregularities of alignment of the teeth in order to improve position, appearance and function of crooked or abnormally arranged teeth. They provide these services predominately to NHS patients and also to some private patients. The practice receives dental referrals from dental practices all over the North West, Cheshire, Shropshire, The Wirral and North Wales.

The practice is open:

Monday, Tuesday, Thursday and Friday 9am – 1pm and 2pm – 5pm and Wednesday 9am – 1pm 2pm – 6pm.

The principal dentist is the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the practice is run.

We received feedback from 35 patients about the service. The 31 CQC comment cards seen and four patients spoken to reflected very positive comments about the staff and the services provided. Patients commented that the practice appeared clean and tidy and they found the staff very caring, friendly and professional. They had trust and confidence in the dental treatments and said explanations from staff were clear and understandable. They told us appointments usually ran on time and they would highly recommend the practice.

Our key findings were:

  • The practice reported and recorded accidents and complaints. They did not have a significant event analysis policy and procedures in place; however were to implement a system soon.
  • Staff had received safeguarding training and knew the processes to follow to raise any concerns.
  • There were sufficient numbers of suitably qualified staff to meet the needs of patients.
  • Staff had been trained to deal with medical emergencies and emergency medicines and emergency equipment were available.
  • Infection prevention and control procedures were in place.
  • Patients’ care and treatment was planned and delivered in line with evidence based guidelines, best practice and current legislation within their specialist field.
  • Patients received clear explanations about their proposed treatment, costs, benefits and risks and were involved in making decisions about it.
  • Patients were treated with dignity and respect and their confidentiality was maintained.
  • The appointment system met the needs of patients and waiting times were kept to a minimum.
  • The practice staff felt valued, involved and worked as a team.
  • The practice took into account any comments, concerns or complaints and used these to help them improve.

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

  • Review the storage of dental care records to ensure they are stored safely and meet health and safety and fire regulations in accordance with the Department of Health’s code of practice for records management (NHS Code of Practice 2006) and other relevant guidance about information security and governance.
  • Review the practice’s system for the 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 storage of clinical waste to ensure it was safe and secure.
  • Review the access to the local decontamination unit (LDU).
  • Review fire safety training to ensure staff undertake this annually and fire safety drills six monthly.
  • Review the protocol for completing accurate, complete and detailed records relating to employment of staff. This includes making appropriate notes of verbal references taken and ensuring recruitment checks, including references, are obtained and recorded.
  • Review the availability of an interpreter service for patients who do not speak English as their first language.

We also found areas of notable practice:

  • Dentists, therapists and dental nurses all had specialist skills supported by enhanced skills training. They worked well as a team supporting each other and were able to undertake extended roles such as in radiography and impression taking.
  • All patients had their treatment peer assessed and rated using the orthodontic peer assessment rating (PAR) index. Staff were all trained and calibrated in PAR. (The PAR index is a robust way of assessing the standard of orthodontic treatment that an individual provider is achieving and determining the outcome of the orthodontic treatment in terms of improvement and standards). In orthodontics it is important to objectively assess whether a worthwhile improvement has been achieved in terms of overall alignment and occlusion for an individual patient or the greater proportion of a practitioner's caseload. This practice quality assured all their patients treatment using the PAR index.