Welwyn Dental Practice

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.

Clinical 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 although these had not always been well documented. Staff felt that risks were well managed at the practice and stated that they felt able to raise concerns and that these would be listened to and acted upon.

The premises were visibly 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, and fire safety equipment was available. However, we noted some required emergency equipment and medicines were missing and the provider was not completing checks of the equipment in line with national guidance. The practice did not have buccal midazolam (a medicine used to manage seizures), portable suction or a child-size self-inflating bag with reservoir. Some sizes of face masks and oropharyngeal airways (a medical device used in airway management to maintain or open a patient’s airway) were also missing. Glucagon (a medicine used to manage low blood sugar) was stored in a fridge but staff did not monitor the temperature of the fridge to ensure the medicine was stored at the manufacturer’s recommended temperature. Other items, such as eyewash and spillage kits used for bodily fluids were also not present. We were provided with evidence to show that all the missing items were ordered immediately following the assessment.

The practice had risk assessments to minimise the risk that could be caused from substances that are hazardous to health. The practice had systems to assess, monitor and manage risks to patient and staff safety. However, these were not always effective. For example, risk assessments were not practice specific and had not identified all risks to staff, such as lone working or a damaged carpet. The practice used safety sharp devices but had not included these as control measures in the sharps risk assessment. The practice had systems for appropriate and safe handling of medicines but did not carry out antimicrobial prescribing audits. The practice ensured the facilities were maintained in accordance with regulations. However, we did not see evidence that the practice had obtained a satisfactory electrical installation condition report. Following our feedback, this test was booked for 29 November 2024. A fire safety risk assessment had been completed. Staff told us smoke alarms were periodically tested and fire evacuation drills were undertaken. However, we were not assured the fire risk assessment was completed by a competent person, and there were no records to evidence regular smoke alarm testing and fire evacuation drills. After the assessment the provider showed evidence, they were arranging a fire risk assessment to be undertaken by a specialist company. X-ray equipment was serviced on 8 November 2024. On the day of the assessment some required radiation protection information was not available. In particular, registration with the Health and Safety Executive (HSE) for the use of ionising radiation and local rules were not available. We were not provided with evidence that the practice had a contract to obtain radiation protection advice, and the last 3-yearly performance check was undertaken in 2019, so was overdue. After our feedback the provider sent evidence that these shortfalls were in process of being rectified.

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 and ongoing informal discussions. They also discussed learning needs, general wellbeing and aims for future professional development. One staff member stated, “I am always being told how well I am doing”. However, they told us that they did not receive an annual appraisal. 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 ensured clinical staff were qualified, registered with the General Dental Council and had appropriate professional indemnity cover. The practice did not have a recruitment policy or procedures which reflected relevant legislation. We saw no evidence that appropriate recruitment checks had been completed for staff who had been working at the practice for many years. Improvement was needed to ensure the provider checked all information required in respect of persons employed or appointed for the purposes of a regulated activity as set out in Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Immediately after the assessment the provider provided evidence that Disclosure and Barring Service (DBS) checks were being undertaken. The provider did not have oversight of staff training as there was no system to ensure staff training was up-to-date and reviewed at the required intervals. We noted some members of staff had not completed all mandatory training. We did not see evidence that new staff were provided with an induction.

We saw the practice was visibly clean and equipment for environmental cleaning was segregated and stored safety. Improvement could be made to ensure the practice followed the British Institute of Cleaning Science guidance in the colour coding for cleaning different areas of the practice and that a cleaning schedule was followed. Staff followed infection control principles, including the use of personal protective equipment. We observed the decontamination of used dental instruments, which mostly aligned with national guidance. Improvements could be made to the signage for zoning of clean and dirty areas of the dental surgery, and to ensure the box used for the transportation of contaminated dental instruments had a lid that could be secured. We saw clinical staff had appropriate training in infection prevention and control (IPC). However, improvements were required to ensure effective IPC auditing. On the day of the assessment, we saw a number of undated and incomplete IPC audits. An audit that was dated from 2022 did not include an action plan. Staff confirmed IPC audits had not been completed at the recommended frequency in line with national guidance.

The practice had infection control procedures which mostly reflected published guidance and the equipment in use was maintained and serviced. Staff demonstrated knowledge and awareness of infection prevention and control processes, and we saw single use items were not reprocessed. Staff described how instruments that could be used for patients during the day were kept in unsealed pouches in drawers in the dental surgery and that any instruments that were not used would be resterilised at the end of the day. However, we observed un-pouched dental instruments and handpieces in drawers in the surgery and were not assured these would all be resterilised in line with guidance if not used. The practice had procedures to reduce the risk of Legionella, or other bacteria, developing in water systems, in line with a risk assessment. However, improvements were required to ensure these were effective. We were told that water quality checks were undertaken although records were not available to demonstrate this, and recommended actions identified in risk assessments were not addressed in a timely manner. We saw a recommended action to complete monthly water temperature checks from a risk assessment completed by an external company in 2022, was identified again as requiring immediate action in the risk assessment undertaken in the days prior to our on-site assessment. The practice had procedures in place to ensure clinical waste was segregated and disposed of safely in line with guidance. Improvement could be made to ensure that the clinical waste container was secured to a fixed structure.

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