We carried out an announced comprehensive inspection on 18 November 2015 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.

Background

Aesthetic Dental Solutions is situated in a converted three storey residential property in a conservation area of Lytham St Anne’s Lancashire. There are four treatment rooms in total one on the ground floor and three on the first floor. The staff group consists of the principal dentist/owner, three associate dentists, a periodontics specialist, a dentist with a special interest in endodontics and a visiting oral surgeon. There are two dental therapists, six dental nurses a receptionist and the practice manager.

On the day of the inspection there were three dentists working in the practice, they were supported by five dental nurses, a receptionist and the practice manager.

The practice provides private dental services for adults and children. The practice offers a range of dental services including routine examinations and treatment, implants, tooth whitening, veneers, crowns and bridges, root canal treatments and oral hygiene. The practice also offers conscious sedation.

The practice was open Monday, Wednesday and Thursday from 8.30am until 5.30pm, Tuesday 8.30am until 6pm and Friday from 8am until 2pm. Saturday mornings by appointment.

The practice provides predominantly (80%) NHS treatments and a smaller number of treatments (20%) privately or with Denplan (a payment method).

The practice manager was in the process of completing an application to register with the Care Quality Commission as 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 some concerns about staff training in relation to intra-venous sedation at this practice. As a result the inspection was only announced the day before the visit which meant the provider was not sent any CQC comment cards for patients to complete. We spoke with four patients during the inspection and reviewed the completed NHS Friends and Family test cards.

Our key findings were:

• The practice had access to equipment for use in the event of a medical emergency such as an automated external defibrillator and medical oxygen in accordance with the Resuscitation Council UK guidance.
• There were good governance systems in place to monitor patients prior to, during and after treatment under intra venous sedation.
• The provider had emergency medicines in line with the British National Formulary (BNF) guidance for medical emergencies in dental practice.
• Governance arrangements were in place to ensure the smooth running of the practice.
• Patients’ needs were assessed and care was planned in line with current guidance such as from the National Institute for Health and Care Excellence (NICE).
• Staff had received formal safeguarding training and knew the processes to follow to raise any concerns.
• Dental care records were detailed and demonstrated on-going monitoring of patients’ oral health.

• Patients' were involved in their care and treatment planning so they could make informed decisions.
• Patients we spoke with told us they were treated with compassion and respect and staff were professional and friendly.
• Staff had received training appropriate to their roles and were supported in their continued professional development (CPD).
• Equipment, such as the air compressor, autoclaves (steriliser), fire extinguishers, and X-ray equipment had all been checked for effectiveness and had been regularly serviced.
• There was a business continuity plan in place to deal with foreseeable emergencies that could impact on the running of the practice.
• The practice achieved the Investors in People accreditation in April 2015.

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

• Ensure that endodontic files are clearly labelled after the decontamination process and include not only the patients full name but also a date of birth to prevent any possible errors where patients have the same name.
• Devise a method of checking and recording that the visiting dental professionals have up to date cardiopulmonary resuscitation (CPR) training.

Ensure the Local rules contain the names of the staff authorised to use the X-ray equipment.

We spoke to a range of people about the service. They included, dentists, the practice manager, staff and patients who use the service. This is in order to gain a balanced overview of what people experience.

We spoke with people who use the surgery about how they were treated and support they received. They told us staff were good at discussing all their treatment options and given time to make informed decisions. Comments included, "They always keep me informed of my treatment and cost." Also, "We went through all the options from the start."

Patients spoke very highly of staff and how they were treated with respect and politeness. One patient said, "The girls on reception are excellent, they calm you down and are always polite." Another patient we spoke with said, "I am very anxious when I come here but the staff are good at calming me down and always have time to talk with me."

None of the people we spoke with had any issues about the standard of care they were receiving and people told us that they would be comfortable in raising any concerns they may have.