Stotfold Dental Practice - Stotfold

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 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. During our assessment of this key question, we found concerns related to safe and effective staffing, in particular the recruitment of staff, which resulted in a breach of Regulation 19 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 the majority had completed training in emergency resuscitation and basic life support every year. However, 1 staff member had not completed any any sepsis training. Following the inspection, we saw that this training had been completed. 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 but were being checked on a monthly basis. This was not in accordance with national guidance which states these must be checked weekly. The practice told us this will now be implemented. Staff could access these in a timely way. The premises were clean, well maintained and free from clutter. Hazardous substances were clearly labelled and stored safely. We saw satisfactory records of servicing and validation of equipment in line with manufacturer’s instructions, although these were not always readily available. Fire exits were clear and well signposted. At the time of inspection, building work was being carried out and for safety reasons, the rear fire exit door had been locked and was not being used as a fire exit. However, the original signage illustrating this was a fire exit had not been removed. Following the inspection, we saw that the signage had been removed and the evacuation route modified. The fire extinguishers and fire alarms were serviced and well maintained. We noted that the door to the staff room was labelled as a fire door, yet the door was not fitting in the frame and hence potentially, would not function effectively.

The practice ensured equipment was safe to use, 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. Emergency lights were serviced in 2019. Fire alarms were tested monthly; guidance states this should be carried out weekly. Following the inspection, we saw that a service for the emergency lights was booked and we were informed that alarms would be tested weekly. The practice had some arrangements to ensure the safety of the X-ray equipment. This included cone-beam computed tomography (CBCT). However, the practice had not informed the Health and Safety Executive of the use of ionising radiation. After the inspection, we saw that this had been undertaken. We were told during the inspection, that a laser was used in the practice. Whilst a risk assessment had been completed, no Laser Protection Advisor (LPA) had been appointed and there were no local rules. After the inspection, we saw that the practice had started the process to appoint an LPA. The practice had risk assessments to minimise the risk that could be caused from substances that are hazardous to health. The practice had implemented systems to assess, monitor and manage risks to patient and staff safety, for example sharps safety. We found that risks had not been fully assessed regarding lone working, which was rectified following the inspection. The practice did not have a comprehensive system for the appropriate and safe handling of medicines. NHS prescriptions were not monitored to prevent fraudulent misuse. Antibiotics were being dispensed from the practice and the stock control was ineffective. The practice told us they would implement a prescription log and that the stock control of medicines would be improved. Antimicrobial prescribing audits were not carried out and should be implemented.

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.

Most 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. Staff discussed their training needs during annual appraisals 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. Staff told us they had received a structured induction programme, which included safeguarding.

The practice did not have a recruitment policy to help them employ suitable staff. We saw that satisfactory evidence of conduct in previous employment was not requested, no evidence of immunity to Hepatitis B was obtained, no full employment history was requested and no information about any physical or mental health conditions which was relevant to the person’s capability was recorded. Whilst we saw that the principal dentist had an enhanced DBS certificate, all other staff members had a basic DBS certificate. Following the inspection, the practice showed us a recruitment policy to which they would adhere. We were also told that enhanced DBS checks were being applied for and staff had been advised to arrange a blood test to ensure immunity to Hepatitis B. There were no recruitment checks or DBS certificates for the cleaners who were in the building unsupervised. Following the inspection, we were told that this will be requested. The practice ensured clinical staff were qualified, registered with the General Dental Council and had appropriate professional indemnity cover. Newly appointed staff had a structured induction, and clinical staff completed continuing professional development required for their registration with the General Dental Council. The practice had arrangements 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 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. However, we found that the external clinical waste bin, which was accessible to the public, was left unlocked due to the absence of a key. Following the inspection, we were shown that this was now lockable. We observed the decontamination of used dental instruments, which aligned with national guidance.

The practice had infection control procedures which reflected published guidance and the equipment in use. Staff had appropriate training, and the practice completed Infection prevention and control (IPC) audits in line with current guidance. 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 policies and procedures in place to ensure clinical waste was segregated and stored appropriately in line with guidance.

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