Orthodontic Practice Tring

We carried out this announced comprehensive inspection on 27 April 2023 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 advisor.

To get to the heart of patients’ experiences of care and treatment, we always ask the following 5 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:

• The dental clinic appeared clean and well-maintained.
• Clinical staff provided patients’ care and treatment in line with current guidelines.
• Patients were treated with dignity and respect. Staff took care to protect patients’ privacy and personal information.
• Staff provided preventive care and supported patients to ensure better oral health.
• The appointment system worked efficiently to respond to patients’ needs.
• The frequency of appointments was agreed between the dentist and the patient, giving due regard to National Institute of Health and Care Excellence (NICE) guidelines.
• Staff felt involved, supported and worked as a team.
• Staff and patients were asked for feedback about the services provided.
• Complaints were dealt with positively and efficiently.
• Safeguarding processes were in place and staff knew their responsibilities for safeguarding vulnerable adults and children.
• The practice had a staff recruitment policy which reflected current legislation. However, staff records were incomplete as they did not contain proof of identification, satisfactory evidence of conduct in previous employment or evidence of satisfactory protection against Hepatitis B.
• Staff knew how to deal with medical emergencies. However, not all appropriate medicines and life-saving equipment were available.
• Some of the practice’s infection control procedures did not reflect published guidance.
• The practice did not have an effective system to receive, action and cascade safety alerts.
• The practice had limited systems to help them manage risk to patients and staff. There were shortfalls in the assessment and mitigation of risks in relation to management of medical emergencies, servicing of equipment, and the Control of Substances Hazardous to Health.

Background

Orthodontic Practice - Tring is in the town of Tring in Hertfordshire and provides NHS and some private orthodontic treatment for adults and children.

There is a portable ramp for access to the practice for people who use wheelchairs and those with pushchairs. Car parking spaces, including dedicated parking for disabled people, are available near the practice. The practice has made reasonable adjustments to support patients with access requirements.

The dental team includes 1 specialist orthodontist, 2 dental nurses, and 1 receptionist. The practice has 1 treatment and 1 consultation room.

During the inspection we spoke with the dentist, 1 dental nurse, and the receptionist. We looked at practice policies, procedures and other records to assess how the service is managed.

The practice is open:

Mondays, Tuesday, and Thursdays from 8.45am to 5pm

Fridays from 8.45am to 1pm.

We identified regulations the provider was not complying with. They must:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

Full details of the regulations the provider was not meeting are at the end of this report.

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

• Take action to ensure audits of radiography, record keeping, and infection prevention and control are undertaken at regular intervals to improve the quality of the service. Practice should also ensure that, where appropriate, audits have documented learning points and the resulting improvements can be demonstrated.

• Take action to implement any recommendations in the practice's Legionella risk assessment, taking into account the guidelines issued by the Department of Health in the Health Technical Memorandum 01-05: Decontamination in primary care dental practices, and having regard to The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance.’ In particular, by recording the sentinel hot and cold-water temperatures.

• Implement an effective system for receiving and responding to patient safety alerts, recalls and rapid response reports issued by the Medicines and Healthcare products Regulatory Agency, the Central Alerting System and other relevant bodies, such as Public Health England.