Rainford Orthodontic Practice

We carried out this announced focused inspection on 26 April 2022 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 practice was meeting the legal requirements in the Health and Social Care Act 2008 and associated regulations. The inspection was led by a Care Quality Commission, (CQC), inspector who was supported by a specialist dental adviser.

To get to the heart of patients’ experiences of care and treatment, we usually ask five key questions, however due to the ongoing COVID-19 pandemic and to reduce time spent on site, only the following three questions were asked:

• Is it safe?

• Is it effective

• Is it well-led?

These questions form the framework for the areas we look at during the inspection.

Our findings were:

• The dental clinic was visibly clean and well-maintained.
• The practice had infection control procedures which reflected published guidance. We discussed ways in which these could be strengthened.
• Staff knew how to deal with medical emergencies. Appropriate medicines and life-saving equipment were available.
• The practice had systems to help them manage risk to patients and staff. Some information in relation to radiography required completion.
• Safeguarding processes were in place and staff knew their responsibilities for safeguarding vulnerable adults and children. Details of local authority safeguarding leads, outside the immediate area, required adding to policy and flow charts for staff to refer to.
• The practice had staff recruitment procedures which reflected current legislation. In some cases, documents held for some staff did not confirm their immunity to blood borne diseases.
• The clinical staff provided patients’ care and treatment in line with current guidelines.
• Patients were treated with dignity and respect and staff took care to protect their privacy and personal information.
• Staff provided preventive care and supported patients to ensure better oral health.
• The appointment system took account of patients’ needs.
• There was effective leadership; staff felt involved and supported and worked as a team.
• Staff and patients were asked for feedback about the services provided.
• Complaints were dealt with positively and efficiently.
• The dental clinic had information governance arrangements.

Background

The provider has two practices and this report is about Rainford Orthodontic Practice.

Rainford Orthodontic Practice is in Rainford, St Helens and provides NHS and private orthodontic care and treatment for adults and children.

There is level access to the practice for people who use wheelchairs and those with pushchairs. Car parking spaces are available near the practice. The practice has made adjustments to support patients with additional needs, for example a ground floor treatment room that is fully accessible and an accessible patient toilet which also has baby change facilities. There is also an oral health education room, where patients can be given one to one instruction and education on how to maintain their oral health whilst going through their orthodontic treatment.

The practice team includes three orthodontists, seven orthodontic nurses, two orthodontic therapists, a practice manager and one receptionist. The practice has four treatment rooms.

During the inspection we spoke with two orthodontists, one orthodontic nurse 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 9am - 6pm, Tuesday 10am – 7pm, Wednesday and Thursday 8am – 5pm, Friday 9am to 5pm and one Saturday in three from 9am to 12pm.

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

Improve the practice's risk management systems for monitoring and mitigating the various risks arising from the undertaking of the regulated activities. In particular:

• Review safeguarding policies and details held of safeguarding leads across Merseyside to ensure these meet the needs of staff at the practice and; check the fire safety risk assessment to ensure oxygen warning signs are located correctly for emergency services attending the practice.
• Link recruitment records held on staff immunity to bloodborne diseases with six monthly infection control audits, to ensure audits are completed accurately.
• Audit hot water temperature records to ensure staff test hot water to 55 degrees centigrade in relation to Legionella management.
• Review checks on emergency equipment and lists of equipment held to ensure both meet requirements in that all equipment is held within the kit.
• Update local rules for radiography equipment and review audit of radiography to ensure these are sufficiently detailed.