We carried out this announced inspection on 13 June 2018 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 provider was meeting the legal requirements in the Health and Social Care Act 2008 and associated regulations. The inspection was led by a CQC inspector who was supported by a specialist dental adviser.

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

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

St Annes Dental Clinic is in Lytham, St Annes and provides private and NHS general dental service and orthodontic treatments to adults and children.

The practice is situated on the first floor of the building. It is separated into two separate dental areas; general NHS dentistry and private orthodontic and dental implant treatments. Each area has it's own separate access and waiting room. If patients report to the wrong reception area they are asked to access the correct area from the separate entrance and stairs. Staff can move between the two practices but this is restricted for patients. There is no access for people who use wheelchairs. Car parking spaces, including spaces for blue badge holders, are available near the practice.

The dental team includes six dentists, 14 dental nurses (One of whom is the clinical lead, one is a full time receptionist and one of whom is a trainee) and an administration lead.  The role of the practice manager is split between the administration lead and the clinical lead (manager leads). The practice has seven treatment rooms.

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.

On the day of inspection, we collected 23 CQC comment cards filled in by patients.

During the inspection we spoke with the principal dentist, two associate dentists, two dental nurses, the receptionist and two dental nurses working on reception, the administrator and the two manager leads. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday Tuesday and Thursday 9.00am – 6.00pm

Wednesday 9.00am – 5.30pm

Friday 9.00am – 2.00pm

The practice is open until 8.00pm on the second and fourth Thursday of each month and between 8.30am – 12.30pm every second and fourth Saturday of the month.

Our key findings were:

• The practice appeared clean and well maintained.
• The practice had infection control procedures
• Staff knew how to deal with emergencies. Not all appropriate medicines and life-saving equipment were available.
• The practice had systems to help them manage risk but some improvements could be made.
• The practice staff had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• The practice had thorough staff recruitment procedures.
• The clinical staff provided patients’ care and treatment in line with current guidelines.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• The practice was providing preventive care and supporting patients to ensure better oral health.
• The appointment system met patients’ needs.
• The practice had effective leadership and culture of continuous improvement.
• Staff felt involved and supported and worked well as a team.
• The practice asked staff and patients for feedback about the services they provided.
• The practice staff dealt with complaints positively and efficiently.
• The practice staff had suitable information governance arrangements.

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

• Review the availability of equipment to manage medical emergencies taking into account the guidelines issued by the Resuscitation Council (UK), and the General Dental Council standards for the dental team and sedation guidelines.

This is a busy practice, with treatment being carried out throughout the inspection visit. However, at some point we did speak to the dentists in the surgeries as well as a range of staff working in the practice. We also spoke to some patients waiting for treatment. This helped us to gain a balanced overview of what people experience using the practice.

We asked some people waiting for treatment to talk to us about their experiences using the service. They were very positive about the way they were treated by staff, and were happy with the care and support shown to them during the course of their treatment. Comments from patients included, “I am a nervous patient, but my dentist made me feel very comfortable. In fact all the staff are very good.” Also, "All the staff are very respectful."

During the inspection we observed both reception areas and saw patients were spoken to with respect. We observed people being made to feel comfortable, and staff responsible for their care communicated well with them. One person told us, “I rang with a problem this morning and they have kindly sorted out this appointment for my husband.”

People we spoke to told us they are provided enough information about their treatment options and were kept informed about how their treatment was progressing throughout the process. One patient said, "The dentist talks about what treatment I need, and the cost of it." Staff we spoke to told us, " We make sure every patient has all the information they need about their treatment and costs. We don’t carry out any treatment until it has been agreed by the patient, or, if a child their parent or guardian.”

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