Wraysbury 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 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 fire safety, control of hazardous substances, management of medical emergencies, recruitment and training of staff, sharps safety and infection prevention and control standards being followed at the practice. This resulted in a breach of Regulations 12 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. Whilst there are issues to be addressed, the impact of our concerns relate to the governance and the oversight of the risks, rather than a patient safety risk.

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 all but one had completed training in emergency resuscitation and basic life support in the previous 12 months. Staff we spoke with told us that equipment and instruments were well maintained and readily available. Staff felt confident that risks were well managed at the practice, and the reporting of risks was encouraged.

Emergency equipment and medicines were not managed effectively and checked in accordance with national guidance. Evidence to demonstrate that weekly checks of the defibrillator (AED) and emergency equipment was not available. A size 3 oropharyngeal airway 'use by date' was 06/2024. We have since received evidence to confirm this had been addressed. An eyewash kit was not available. We have since received evidence to confirm this had been addressed. Volumatic spacers (3) were stored outside of protective covering (bags). The blood and bodily fluid spill kit was out of date. We have since received evidence to confirm this had been addressed. Glucagon was stored in a fridge. The fridge was not monitored to ensure its’ temperature remained between 2 and 8 degrees Celsius. A size 5 oropharyngeal airway 'use by date' was 05/2023. We have since received evidence to confirm this had been addressed. A size 4 clear facemask for the self-inflating bag was not available. We have since received evidence to confirm this had been addressed. An AED child pad was not available which was against manufacturers’ guidance. We have since received evidence to confirm this had been addressed. Hazardous substances used in the treatment room were stored in unmarked containers. Storage areas were not signed appropriately in line with Control of Substances hazardous to health (COSHH) guidance. The oxygen cylinder storage location was not signed appropriately to warn of risk. The fire exit was clear and well signposted. The practice did not have effective systems for appropriate and safe handling of medicines. NHS prescriptions were not monitored to prevent fraudulent misuse. Antimicrobial prescribing audits were not carried out. Improvements could be made to implement audits for prescribing of antibiotic medicines taking into account the guidance provided by the College of General Dentistry.

Improvements were needed to ensure that equipment was safe to use and maintained and serviced according to manufacturers’ instructions. The practice did not ensure the facilities were maintained in accordance with regulations. The management of fire safety was not effective. A five yearly electrical fixed wiring test was unsatisfactory, evidence to demonstrate that remedial action taken was not available. A fire risk assessment was carried out 10 months prior to our visit. Actions resulting from this assessment remained outstanding. Evidence of portable appliance testing was not available. The general waste bin was not lockable, or tethered away from the building if locking was not possible. Battery operated smoke detectors were tested monthly. Guidance states testing should be carried out weekly. Annual fire drills were not carried out. Four out of 5 staff had not completed fire safety training in previous 12 months. We have since received evidence to confirm training has been completed by three staff. The practice had arrangements to ensure the safety of the X-ray equipment and the required radiation protection information was available. However, the local rules did not reflect the current x-ray equipment being used. The practice had not implemented systems to assess and manage risks to patient and staff safety. This included management of substances hazardous to health, sharps safety and sepsis awareness. Control of substances hazardous to health (COSHH) safety data sheets were not available for any of the COSHH applicable products used in the practice. A sharps risk assessment was not available. The occupational health service telephone number (for sharps injury advice) was updated in 2012. The provider was unable to confirm the telephone number was still relevant. Not all of the staff were aware of the detection and management of Sepsis. We have since received evidence to confirm training has been completed by 2 of the five staff.

At the time of our assessment, the patients we asked felt there were enough staff working at the practice. They were able to book appointments when needed.

Staff we spoke with told us that there were sufficient staffing levels. Staff said they felt respected, supported and valued. They were proud to work in the practice. Staff discussed their general wellbeing at practice team meetings and ongoing informal discussions. 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, but improvements were needed. A basic DBS certificate, or risk assessment, for a non-clinical staff member was not available. Conduct in previous employment evidence for 2 staff members was not available. Hepatitus B immunity status was not known for either of the 2 clinical staff. Improvements could be made to take action to ensure that all clinical staff have adequate immunity for vaccine preventable infectious diseases. Training was not monitored effectively to ensure staff were up to date with mandatory training. In particular, evidence of Safeguarding children training (specific to role) for 2 staff was not available. We have since received evidence to confirm training has been completed by 1 staff member. Evidence of Safeguarding vulnerable adults training (specific to role) for 2 staff was not available. We have since received evidence to confirm training has been completed by 1 staff member. Evidence of Basic life support training for 1 staff member was not available. The practice ensured clinical staff were qualified, registered with the General Dental Council and had appropriate professional indemnity cover. Induction checklists were not completed by new staff. 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.

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. Staff followed infection control principles, including the use of personal protective equipment (PPE). A spare back up autoclave was not serviced which meant it could not be used in an emergency. The patient chair covering in the treatment room was not complete (a repair patch was lifting up). The floor covering and skirting joints in the treatment room were not sealed. Hazardous waste was segregated appropriately but the clinical waste bin was neither lockable nor tethered to a fixed point to prevent removal from the premises. We have been advised that the waste contractor has been asked to replace the bin. We observed the decontamination of used dental instruments aligned with national guidance.

The practice had infection control procedures which reflected published guidance and the equipment in use. Cleaning equipment (mops) were not stored appropriately. We have since received photographic evidence which confirms mops are stored appropriately. Infection prevention and control training certificates were not available for either of the 2 clinical staff. We have since received evidence which confirms that one staff member has since carried out training. 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. However, the practice was unable to locate the legionella risk assessment.

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