Langman and Associates Dental Practice - Warwick

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. We did not see evidence that 1 staff member had completed training in emergency resuscitation and basic life support every year. We were assured that this training had been included as part of a recently completed professional training course. Evidence was available to demonstrate that all other staff had completed this training. 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. Cleaning schedules completed by the external cleaning company had been removed from the premises, the practice was therefore unable to demonstrate that daily cleaning had been completed. There was no colour coded cleaning equipment on the premises as this had also been removed by the external cleaning company. The provider was trying to resolve this issue with the cleaning company. On the day of assessment, we saw that 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. Fire exits were clear and well signposted. Not all records were available to demonstrate the servicing and maintenance of fire safety equipment.

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. Some issues for action remained outstanding from the risk assessment completed in 2013 and reviewed in 2016 and 2023. Improvements were required to the management of fire safety. Following this assessment, we were forwarded evidence to demonstrate that a fire risk assessment had been booked for 5 August 2024 and we were assured that any issues identified would be acted upon. We identified some issues for action relating to the servicing and maintenance of fire safety equipment. The fire alarm was due for service in March 2024, but this had not been completed. We were assured that this was scheduled for September 2024. There were no records to demonstrate that emergency lighting was checked on a monthly basis. Staff had only very recently introduced checks of fire safety systems and equipment such as the alarm, exit routes and fire extinguishers. Records were available for July, there were no records prior to this date. We were assured that a system had been introduced and weekly checks would be completed going forward. The practice had arrangements to ensure the safety of the X-ray equipment and the required radiation protection information was available. 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. This included sharps safety, sepsis awareness and lone working. The practice had systems for appropriate and safe handling of medicines. Antimicrobial prescribing audits were carried out.

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 ongoing informal discussions. We were told that annual appraisal meetings had not taken place recently but were to be scheduled for this year. Following this assessment, we were told that appraisal meetings had been arranged for 2 dates in September 2024. Although there were no formally documented appraisal meetings, staff told us that they could discuss training and learning needs and general wellbeing with the practice manager or compliance manager at any time. Staff we spoke with demonstrated knowledge of safeguarding and were aware of how safeguarding information could be accessed and knew their responsibilities for safeguarding vulnerable adults and children. Staff told us they had received a structured induction programme, which included safeguarding.

The practice had a recruitment policy and procedure to help them employ suitable 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. 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 some arrangements to ensure staff training was up-to-date and reviewed at the required intervals although some improvements were required. We were not provided with evidence to demonstrate that 1 staff member had completed basic life support training within the last 12 months, or safeguarding adults or children training within the required timescale, or that 1 staff member had completed safeguarding adults training to the required level. Following this assessment, we were sent evidence to demonstrate that those staff who had not completed fire safety training within the last 2 years had now completed this training. Evidence was also sent that staff had completed learning disabilities and autism awareness training. We saw the practice had effective processes to support and develop staff with additional roles and responsibilities.

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. The practice had a contract with an external cleaning company who undertook cleaning at the practice every day it was open. There was no evidence of an effective schedule in place to ensure it was kept clean and no colour coded cleaning equipment. We were told that the cleaning company had removed these from the premises. We were shown correspondence requesting this information from the cleaning company. We were told about the alternative arrangements that were being put in place to ensure compliance with the NHS National Standards of Healthcare Cleanliness. Staff followed infection control principles, including the use of personal protective equipment (PPE). Hazardous waste was segregated and disposed of safely. The clinical waste bin was stored in an area accessible to the public but was not secured to prevent unauthorised removal from the premises. 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 was maintained and serviced. Two of the dental chairs required repair as material on arm rests was ripped and therefore effective cleaning could not be guaranteed. Some areas in the decontamination room such as shelving and flooring required repair to ensure effective cleaning of that area. We were assured that action would be taken to address these issues and were given a date in July by which this action would be taken. 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 legionella risk assessment was completed in November 2022 prior to the installation of a new boiler and changes made to 2 surgeries at the practice. Hot water temperature monitoring records show temperatures consistently below 50 degrees Celsius. Records do not clearly demonstrate that water from sentinel taps is being monitored. An external professional was booked to complete a new risk assessment on 8 August 2024, and we were assured that any issues identified would be acted upon. We were also told that the boiler temperature would be adjusted to ensure water was at the correct temperature. The practice had policies and procedures in place to ensure clinical waste was segregated and stored appropriately in line with guidance. The clinical waste bin was locked when not in use but was stored in a public accessible area and was not secured to the wall or floor to prevent unauthorised removal.

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