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Inspection Summary


Overall summary & rating

Updated 14 January 2016

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.

Inspection areas

Safe

No action required

Updated 14 January 2016

We found that this practice was providing safe care in accordance with the relevant regulations.

There were effective systems and processes in place to ensure all care and treatment was carried out safely. The practice had policies and protocols, which staff were following, for the management of infection control, medical emergencies and dental radiography.

Staff were trained to the appropriate level for child protection and had completed adult safeguarding training. The practice had suitable arrangements for infection prevention and control and clinical waste management. Used dental instruments were decontaminated in line with Health Technical Memorandum 01-05 (HTM01-05).

The provider carried out intra-venous sedation at the practice for patients who were very nervous about dental treatment and required complex dental work such as the provision of dental implants. We found that the provider had put into place robust governance systems to underpin the provision of conscious sedation.

Effective

No action required

Updated 14 January 2016

We found that this practice was providing effective care in accordance with the relevant regulations.

Dental care records were well maintained, detailed and showed patients received a comprehensive assessment of their dental needs including a review of their medical history. Consultations were carried out in accordance with best practice guidance from the National Institute for Health and Care Excellence (NICE) and the Faculty of General Dental Practice (FGDP).Patients were given relevant information to assist them in making informed decisions about their treatment.

Staff who were registered with the General Dental Council (GDC) were up to date with their continuing professional development (CPD) and they were supported to meet the requirements of their professional registration. Staff told us they were well-supported by the principal dentist through informal supervision and ad hoc staff meetings.

Caring

No action required

Updated 14 January 2016

We found that this practice was providing caring services in accordance with the relevant regulations.

Feedback from the four patients we spoke with gave us a positive picture of a friendly, professional, and caring service. Patients told us that they were treated with dignity and respect at all times. Patients confirmed that they received both a detailed verbal description and a treatment plan when a course of treatment was proposed.

Patients with urgent dental needs such as dental pain were responded to in a timely manner, often on the same day.

We observed privacy and confidentiality were maintained for patients attending the practice on the day of the inspection.

Responsive

No action required

Updated 14 January 2016

We found that this practice was providing responsive care in accordance with the relevant regulations.

Patients had access to information via the practice website and there was a practice leaflet with relevant information for patients. Emergency appointment slots were available each day so that patients with dental emergencies received treatment on the same day or within 24 hours. The practice leaflet and website gave details of the local out of hours service for patients to access treatment when the practice was closed.

The practice had a complaints procedure that explained the process to follow and the timescales involved for investigation. The complaint policy included the details of external bodies to whom patients could escalate their concerns if they were unhappy with the response.

Well-led

No action required

Updated 14 January 2016

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

There was a system of audits undertaken to monitor the quality and safety of service provided. Staff received induction training and were given opportunities to maintain their professional development.

Practice meetings were held regularly and a record taken of the meetings. Care and treatment records were audited to ensure standards had been maintained. Staff were encouraged to raise any issues or concerns with the practice manager or principal dentist. Staff we spoke with indicated that they were supported in their roles.