Tower Dental

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We found this practice was providing safe care in accordance with the relevant regulations and had taken into consideration appropriate guidance.

Find out what we look at when we assess this area in our information about our new Single assessment framework.

The judgement for Learning culture is based on the latest evidence we assessed for the Safe key question.

The judgement for Safe systems, pathways and transitions is based on the latest evidence we assessed for the Safe key question.

The judgement for Safeguarding is based on the latest evidence we assessed for the Safe key question.

The judgement for Involving people to manage risks is based on the latest evidence we assessed for the Safe key question.

Staff knew how to respond to a medical emergency and had completed training in emergency resuscitation and basic life support every year. Staff we spoke with told us that equipment and instruments were well maintained and readily available. The provider described the processes they had in place to identify and manage risks. Staff felt confident that risks were well managed at the practice, and the reporting of risks was encouraged.

Emergency equipment and medicines were available and checked in accordance with national guidance. Staff could access these in a timely way. However, staff did not know where the first aid kit was located. When this was found we saw it had expired in January 2024. The premises were clean, well maintained and free from clutter. Hazardous substances were clearly labelled and stored safely. Employers’ liability insurance was not displayed, and staff were not aware of the arrangements in place. Evidence of appropriate insurance was submitted after the inspection. The manager confirmed this would be displayed for staff. We reviewed records of servicing and validation of equipment in line with manufacturer’s instructions. There was no evidence of a pressure vessel inspection for the autoclave or dental compressor. Evidence was submitted to show these were carried out immediately after the on-site assessment. Fire exits were clear and well signposted, and fire safety equipment was serviced and well maintained.

The practice ensured equipment was safe to use and maintained and serviced according to manufacturers’ instructions. The practice ensured the facilities were maintained in accordance with regulations. A fire safety risk assessment was carried out in line with the legal requirements. The management of fire safety was effective. We highlighted staff should document their regular checks of fire detection equipment and extinguishers. We reviewed the arrangements to ensure the safety of the X-ray equipment. The required radiation protection information was not available. Satisfactory evidence was obtained and submitted after the on-site assessment. Risk assessments were not in place for all hazardous substances in use. The practice should improve the practice's processes for the control and storage of substances hazardous to health identified by the Control of Substances Hazardous to Health Regulations 2002, to ensure risk assessments are undertaken. The practice had implemented systems to assess, monitor and manage risks to patient and staff safety. This included sharps safety. We discussed the importance of ensuring instructions for staff to follow in the event of a sharps injury is up to date and readily available. We highlighted staff would benefit from receiving sepsis awareness training and providing sepsis recognition resources to refer to. The practice had systems for appropriate and safe handling of medicines.

At the time of our assessment, the patients felt there were enough staff working at the practice. They were able to book appointments when needed.

Staff we spoke with had the skills, knowledge and experience to carry out their roles. They told us that there were sufficient staffing levels. Staff stated they felt respected, supported and valued. They were proud to work in the practice. Staff discussed their training needs during 1-to-1 meetings, practice team meetings and ongoing informal discussions. There were systems to carry out appraisals, discuss learning needs, general wellbeing and aims for future professional development. Staff we spoke with demonstrated knowledge of safeguarding and were aware of how safeguarding information could be accessed. Staff knew their responsibilities for safeguarding vulnerable adults and children. Staff told us they had received a structured induction programme, which included safeguarding.

A recruitment policy to ensure all essential checks are carried out for new employees in line with relevant legislation could not be found. We reviewed staff files and found pre-employment checks for new staff were not consistently carried out. In particular, Disclosure and Barring Service (DBS) checks, requesting references, and right to work checks where applicable. The health and safety risk assessment stated staff are immunised against Hepatitis B and their responses checked. However, this was not the case for 3 clinical staff members. The practice should implement an effective recruitment procedure to ensure that appropriate checks are completed prior to new staff commencing employment at the practice, and ensure accurate, complete and detailed records are maintained for all staff. The practice ensured clinical staff were qualified, registered with the General Dental Council and had appropriate professional indemnity cover. We highlighted that dental nurses should be provided with the details of the policy they were covered by. Newly appointed staff had a structured induction, but this was not documented. The practice did not have arrangements to ensure staff training was up-to-date and reviewed at the required intervals. After the inspection, evidence was obtained and submitted to show clinical staff completed continuing professional development required for their registration with the General Dental Council. The practice should implement protocols and procedures to ensure staff are up-to-date with their mandatory training and their continuing professional development.

Patients told us that the practice looked clean, and equipment appeared to be in a good state of repair.

Staff told us how they ensured the premises and equipment were clean and well maintained. They demonstrated knowledge and awareness of infection prevention and control processes. Staff told us that single use items were not reprocessed.

The practice appeared clean and there was an effective schedule in place to ensure it was kept clean. Staff followed infection control principles, including the use of personal protective equipment (PPE). Hazardous waste was segregated and disposed of safely. We observed the decontamination of used dental instruments, which aligned with national guidance. We highlighted that instruments should be dried with lint-free cloths.

The practice had infection control procedures which reflected published guidance and staff had appropriate training. The practice completed infection prevention and control (IPC) audits in line with current guidance. However, these had not been completed accurately, and there was no evidence the findings of audits were reviewed. A Legionella risk assessment was in place. However, we were not assured the assessor had the necessary competence. Staff training and practice procedures to reduce the risk of Legionella, or other bacteria, developing in water systems should be improved. Staff were not aware that all lesser used outlets must be flushed, we saw monthly water temperature testing was not being carried out correctly, and the water conditioning agent used in dental unit waterlines was not used in line with the manufacturer’s instructions. The practice should take action to ensure a Legionella risk assessment has been completed by a competent person, and implement any recommendations, 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.’ The practice had procedures in place to ensure clinical waste was segregated and stored appropriately in line with guidance. However, whilst staff were aware to empty waste containing dental amalgam into a specified sink, they did not know how they would identify if the amalgam waste collection vessel was full, and the correct process for disposing of this.

The judgement for Medicines optimisation is based on the latest evidence we assessed for the Safe key question.