The Dental Practice

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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 the safety of the premises and the infection prevention and control standards not being followed at the practice. The concerns resulted in breaches of Regulations 12 (Safe care and treatment) and 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can find more details of our concerns in the evidence category findings below.

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.

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. We noted the practice was overall well maintained but was not free from clutter posing a risk to staff and visitors,. This included a disused autoclave, historic patient records, general office supplies, boxes and folders posing a hazard to staff and difficulty cleaning.

We saw satisfactory records of servicing and validation for most pieces of equipment in line with manufacturers` instructions. Servicing of the Xray had been completed but some actions identified had not been completed. The practice ensured the facilities were maintained in accordance with regulations. A fire safety risk assessment had been carried out the day before our assessment by an external company, in line with the legal requirements. There were a number of areas identified for action in the risk assessment. We also identified fire hazards around the practice on the day of our assessment in relation to clutter. We discussed these risks with the provider, and they assured us that they were taking action to rectify the identified concerns. Fire exits were clear and well signposted. From visual inspection we could see that fire extinguishers were serviced and maintained. However, the provider could not locate the paperwork to confirm the date of the last servicing. There were no records of weekly or monthly fire safety checks. The practice had required radiation protection information however, they had not implemented or followed up on recommendations that had been made during a recent inspection of the equipment. The practice did not have risk assessments or safety data sheets for all hazardous items to minimise the risk that could be caused from substances that are hazardous to health. The practice did not have robust systems to assess, monitor and manage all risks to patient and staff safety. For example, the practice did not have a sharps risk assessment. The practice had systems for appropriate and safe handling of medicines. Antimicrobial prescribing audits were carried out.

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 annual appraisals, 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. There was a lack of oversight in ensuring these procedures were followed and evidence of recruitment checks were not always present. The practice ensured clinical staff were qualified, registered with the General Dental Council and had appropriate professional indemnity cover. We saw confirmation of all clinical staff registration and indemnity. 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 robust arrangements to ensure staff training was up-to-date and reviewed at the required intervals. The oversight of monitoring of staff training required improvement. Whilst some staff were able to verify their CPD to us, there was no systematic monitoring by the practice.

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 the decontamination of used dental instruments, which aligned with national guidance.

The practice had infection control procedures which reflected published guidance. We saw evidence that some staff had appropriate training. The practice completed infection prevention and control (IPC) audits in line with current guidance. However, they did not always identify actions appropriately neither did they follow up on areas that were identified as requiring improvements. For example, disjoined surfaces, sinks with overflows and local anaesthetics not being stored in blister packs. We discussed this with staff, and they told us they would review how they carried out the audit. The practice had procedures to reduce the risk of Legionella, or other bacteria, developing in water systems, in line with a risk assessment. Water temperature testing was completed but there were a number of incidences where the hot temperature had not reached the required temperature, and no action was documented. We discussed this with staff, and they assured us action would be taken. 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.