G K Ooi & Associates - Kennington Road

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• 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 not providing safe care in accordance with the relevant regulations. We will be following up on our concerns to ensure they have been put right by the provider. The impact of our concerns, in terms of the safety of clinical care, is minor for patients using the service. Once the shortcomings have been put right the likelihood of them occurring in the future is low. During our assessment of this key question, we found concerns related to fire safety, hazardous substances, waste management, training and development of staff, sharps safety, lone working and the infection prevention and control standards being followed at the practice. This resulted in breaches of Regulations 12 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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 readily available, however we were told that although equipment had been serviced in the days prior to our inspection, there was no history of mandatory inspections or routine servicing of the compressor or X-ray equipment. The provider described the processes they had in place to identify and manage risks. Staff told us that fire drills and smoke alarm testing were not carried out. However, staff felt confident that overall, 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. The premises were clean, but work surfaces were cluttered. Hazardous substances were not always clearly labelled and stored safely. In particular we observed several syringes of an unlabelled clear liquid. We were told this was sodium hypochlorite (bleach) which is a hazardous substance used during root canal procedures. Incorrect application of this substance could cause irreversible harm. Improvements could be made to ensure a bodily fluids spillage kit was available. We saw records of recent servicing and validation of equipment in line with manufacturer’s instructions. However, there was no evidence to demonstrate previous servicing history for the compressor or X-Ray equipment. The fire exit was clear and signposted, and fire extinguishers were maintained. However, we noted hazardous use of multiple “daisy-chained” extension leads in the reception area adjacent to combustible materials. There was no emergency lighting.

The practice had ensured sterilisation equipment was safe to use and maintained appropriately. A new compressor was installed on the day before our inspection as the existing one was deemed obsolete by the engineer. The practice ensured some of the facilities were maintained in accordance with regulations. Portable appliance testing and air-conditioning servicing was routinely carried out, but the electrical installation condition report was completed the day before our inspection and there was no evidence that this had been carried out at the required intervals. A fire risk assessment was not carried out in line with the legal requirements. The management of fire safety was ineffective. In particular, smoke alarms were not tested, fire drills not carried out and staff had not received fire safety training. Following our inspection, a risk assessment was arranged and staff completed training. X-ray equipment was serviced and safety tested within the days before our inspection although some remedial works were still outstanding. On the day of inspection some required radiation protection information was not available. In particular, registration with the Health and Safety Executive (HSE) for the use of ionising radiation was not available and the local rules were not up to date. Following the inspection, HSE registration was completed. The practice had risk assessments to minimise the risk that could be caused from substances that are hazardous to health. However, processes to handle hazardous substances were not always followed. The practice had not implemented systems to assess and manage risks to patient and staff safety. This included sharps safety, sepsis awareness and lone working. The practice did not have effective systems for appropriate and safe handling of medicines. NHS prescriptions were not monitored to prevent fraudulent misuse; the practice implemented a system following our feedback. Antimicrobial prescribing audits were carried out.

At the time of our inspection, the patients we asked 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 but we identified that some improvements were required especially regarding sepsis awareness and legal and ethical issues. 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 clinical supervision, practice team meetings and ongoing informal discussions. They also discussed 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.

The practice had a recruitment policy and procedure to help them employ suitable staff, including for agency or locum staff. These reflected the relevant legislation. The practice ensured clinical staff were qualified, registered with the General Dental Council and had appropriate professional indemnity cover. We were told by the principal dentist that newly appointed staff had an induction but we did not see evidence of this. On the day of inspection some clinical staff had not completed all continuing professional development required for their registration with the General Dental Council. In particular, staff had not completed training in sepsis awareness and 2 clinical staff members had not completed safeguarding training as per Intercollegiate guidance, training in legal and ethical issues or the recommended 5 hours of radiography training. Following our feedback, we were sent evidence that staff had now completed the required training. The practice had arrangements which worked ineffectively to ensure staff training was up-to-date and reviewed at the required intervals.

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. They demonstrated reasonable 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. However, we noted that work surfaces were cluttered. Local anaesthetic cartridges had been removed from original packaging, exposing them to possible contamination. Hazardous waste was disposed of in an external bin which was locked. However, the bin was situated at the front of the premises on a pedestrian thoroughfare and the bin was not secured to discourage vandalism or theft. We observed the decontamination of used dental instruments, which did not fully align with national guidance. In particular, some instruments were stored unpackaged in treatment rooms. In particular we observed matrix bands and holders, radiograph positioning devices and a syringe set up with needle and local anaesthetic in a treatment room which was not in use on the day of inspection. Instruments were scrubbed in water that was not temperature checked. Manual scrubbing and ultrasonic decontamination was carried out in the treatment rooms. Improvements could be made to move these processes into the dedicated decontamination room.

The practice completed Infection prevention and control (IPC) audits in line with current guidance. Some clinical staff had not completed appropriate training updates at the time of inspection. The practice had procedures to reduce the risk of Legionella, or other bacteria, developing in water systems, in line with a risk assessment. The practice had ineffective policies and procedures in place to ensure clinical waste was segregated and stored appropriately in line with guidance. In particular Gypsum waste was disposed of in clinical waste which was not in accordance with Health Technical Memorandum 07-01, Safe and sustainable management of healthcare waste, which states that gypsum, which is present in plaster casts and certain types of dental mould, should be segregated from other wastes and disposed of in a designated gypsum bin.

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