Specialist Orthodontic Practice

Updated 2 August 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the practice was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

We undertook a focused inspection of Specialist Orthodontic Practice on 11 July 2017. This inspection was carried out to check that improvements to meet legal requirements planned by the practice after our comprehensive inspection on 27 April 2017 had been made. We inspected the practice against one of the five questions we ask about services: is the service well-led. This is because the service was not meeting some legal requirements.

The inspection was undertaken by a CQC inspector.

Updated 2 August 2017

We carried out an announced comprehensive inspection of this practice on 27 April 2017. A breach of legal requirement was found. After the comprehensive inspection, the practice wrote to us to say what they would do to meet legal requirements in relation to Regulation 17 HSCA (RA) Regulations 2014 Good Governance and Regulation 19 HSCA (RA) Regulations 2014 Fit and Proper Persons Employed.

We undertook a focused inspection for Specialist Orthodontic Practice on 11 July 2017. This was to follow up on actions we asked the provider to take after our announced comprehensive inspection. During the inspection in April 2017, we identified that the provider must; ensure the practice's recruitment policy and procedures are suitable and the recruitment arrangements are in line with Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 to ensure necessary employment checks are in place for all staff and the required specified information in respect of persons employed by the practice is held. Ensure the training, learning and development needs of individual staff members are reviewed at appropriate intervals and an effective process is established for the on-going assessment and supervision of all staff. Ensure the storage of records relating to people employed and the management of regulated activities is in accordance with current legislation and guidance. Ensure the practice establishes an effective system to assess, monitor and mitigate the various risks arising from undertaking of the regulated activities.

This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Specialist Orthodontic Practice on our website at www.cqc.org.uk

Our findings were:

Are services well-led?

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

Background

Specialist Orthodontic Practice is located in Epping and provides NHS and private orthodontic treatment to patients of all ages. There is level access for people who use wheelchairs and pushchairs. The premises are on the ground floor and first floor. The practice consists of four

treatment rooms, an X-ray room, two consultation rooms, a decontamination room and a reception area.

The practice is open on Monday, Wednesday and Thursday 8:30am – 5pm, Tuesday 8:30am – 7pm and Friday 08:30am – 1:30pm.

The dental team includes the principal dentist, two associate dentists, an orthodontic therapist, a trainee orthodontic therapist, six dental nurses one of whom is also a receptionist, a practice manager, an administrator, two receptionists, a treatment coordinator and a new patient

coordinator.

The practice is owned by an individual who is the principal dentist there. They have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run.

During the inspection we spoke with the principal dentist, practice manager and the practice administrator. We looked at practice policies and procedures and other records about how the service is managed.

Our key findings were:

• Improvements were seen in all areas where concerns had been highlighted at the comprehensive inspection.
• The practice recruitment policy, procedures and the recruitment arrangements had been reviewed. Employment checks were in place for staff and the required specified information in respect of persons employed by the practice was recorded.
• The training needs of staff had been reviewed; there was a schedule for on-going assessment and supervision in place for all staff.

• The storage of records relating to people employed and the management of regulated activities had been reviewed and systems put in place to ensure records were stored securely and in accordance with current legislation and guidance.

• The practice had put processes in place to establish a system to assess, monitor and mitigate the various risks arising from undertaking the regulated activities.

At our announced inspection on 27 April 2017, there were areas we identified where the provider could make improvements. During our focused inspection on 11 July 2017 improvements were seen in all areas where the provider could make improvements.

• The practice had reviewed its arrangements for receiving and responding to safety alerts 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). The practice manager was responsible for checking alerts and a process was in place to ensure actions were taken where relevant.
• The practice had reviewed its procedures with regards to the Control of Substances Hazardous to Health (COSHH) Regulations 2002. We saw that documentation was up to date and included all potentially hazardous substances relevant to the practice. In addition the practice cleaning company had a COSHH file for staff to refer to and to ensure the risks associated with the use of and handling of these substances were minimised. All clinical staff, the practice manager and the practice administrator had undergone both COSHH and Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013 (RIDDOR) training to ensure the practice had a better understanding of the potential risks and responsibilities associated with COSHH and RIDDOR.
• All staff had completed levels one and two safeguarding training for both adults and children to ensure they are trained to an appropriate level for their role and are aware of their responsibilities.