Orthohemel Limited

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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 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.

Most emergency medicines and equipment and were available and checked in accordance with national guidance. However, on the day of the assessment we saw that the child-size self-inflating bag with reservoir, 4 sizes of clear face mask, paediatric pads for the automated external defibrillator (AED) and the portable suction device were missing and there was only 1 size of needle for the administration of the medicine adrenaline. These missing items were ordered immediately. Glucagon, the medicine used to treat hypoglycaemia (low blood sugar levels) was not stored in accordance with the manufacturer’s instructions. The expiry date of the medicine was reduced appropriately to reflect this. The premises were clean, well maintained and free from clutter. However, cleaning products were stored in an unlocked cupboard which was accessible to patients. This was not in line with Control of Substances Hazardous to Health (COSHH) Regulations 2002. This was rectified immediately after the assessment. We saw satisfactory records of servicing and validation of most dental equipment in line with manufacturer’s instructions. However, there were no records to show that the ultrasonic bath was regularly serviced. Immediately after the assessment the practice provided evidence that the device had been sent away to be serviced.

The practice had not ensured the facilities were maintained in accordance with regulations as the electrical installation condition report (EICR) had not been completed within the last 5 years. Immediately after the assessment we were provided with evidence that an EICR test had been arranged for 19 September 2024. A fire safety risk assessment was carried out in line with the legal requirements. Fire exits were clear and well signposted, and fire extinguishers were serviced and well maintained. We saw that the emergency lighting was tested monthly and that fire evacuation drills were carried out 6-monthly at the practice. However, we did not see evidence that the emergency lighting or the fire-detection equipment had been serviced or in-house testing of smoke alarms was undertaken. Immediately after the assessment we were shown evidence that servicing of the emergency lighting had been arranged for 19 September 2024 and that weekly testing of the smoke alarms had been implemented. The practice had arrangements to ensure the safety of the X-ray equipment and the required radiation protection information was available. The practice had completed risk assessments to minimise the risk that could be caused from substances that are hazardous to health for dental products but had not included all general cleaning products. Completed risk assessments for cleaning products were sent to us following the assessment. The practice had implemented some systems to assess, monitor and manage risks to patient and staff safety. This included sharps safety and sepsis awareness. However, risk assessments were generic in that they referred to safer sharps which were not used in the practice and a risk assessment had not been completed for the cleaner who was a lone worker. This was completed immediately. The practice did not prescribe 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 and valued. They were proud to work in the practice. However, some staff said they did not feel well supported. Some staff discussed their training needs during annual appraisals, 1 to 1 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.

On the day of the assessment the practice did not have a recruitment policy or checklist to help them employ suitable staff, including for agency or locum staff and not all staff files reflected relevant legislation. For example, we saw that satisfactory evidence of conduct in previous employment and employment history were not always requested. The practice had not obtained an enhanced Disclosure and Barring Service (DBS) check to the appropriate level for one clinical member of staff”. Immediately after the assessment we were provided with evidence that an application for a DBS check at the appropriate level had been sent and the practice implemented a recruitment policy and procedure to ensure that appropriate checks are completed prior to new staff commencing employment at the practice. 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 did not have effective arrangements to ensure staff training was up-to-date and reviewed at the required intervals. On the day of the assessment, we were not provided with evidence to show us that all staff including the safeguarding leads in the practice had completed training appropriate to their role. For example, safeguarding children and vulnerable adults as per Intercollegiate guidance and in fire safety and sepsis awareness. Immediately after the assessment we were sent evidence that the safeguarding leads had completed safeguarding training to the appropriate level.

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 that the decontamination of used dental instruments, was not entirely carried out in line with the recommendations of Health Technical Memorandum 01-05: Decontamination in primary dental care dental practices. For example, we saw that a test to validate the cleaning process of the ultrasonic bath was undertaken daily. However, other tests to validate the efficacy of the cleaning process to remove protein and the ultrasonic activity test were not completed. In addition, heavy duty gloves were not provided and there was no effective process to ensure the accurate dilution of cleaning solutions used for manual cleaning. Improvement could be made to the signage showing clean and dirty zones in the surgery and decontamination room and in the labelling of the boxes used for transportation of dental instruments. Immediately after the assessment we were provided with evidence to show that all these shortfalls had been rectified and that additional testing of the ultrasonic bath had been implemented.

The practice had infection control procedures which mostly reflected published guidance and the equipment in use apart from the ultrasonic bath was maintained and serviced. 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 which included treatment of the dental unit water lines, annual external water quality testing and monthly temperature checks. However, a risk assessment to identify other potential risks where Legionella or other bacteria could develop in the water supply had not been completed. After the assessment we were sent evidence that a risk assessment by a competent person had been arranged for 2 October 2024. The practice had policies and procedures in place to ensure clinical waste was segregated and stored appropriately in line with guidance. However, we noted that the clinical waste bins had not been locked after a waste collection on the day of the assessment and were not secured to a fixed structure. This was rectified.

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