Fortune Green Dental Surgery

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 and had completed training in emergency resuscitation and basic life support every year. Improvements could be made to introduce scenario training to help staff manage potential medical emergencies effectively. Following feedback, the service took immediate action and implemented scenario 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.

Although the practice completed weekly checks of the emergency equipment and medicines, the practice did not have all medical emergency equipment required for cardiopulmonary resuscitation, as outlined by the Resuscitation Council UK. In addition, the practice only had access to 1 automated injection device which is used to treat severe allergic reactions and anaphylaxis. Current guidance recommends that intramuscular adrenaline should be given as a first line treatment for anaphylaxis and repeated after 5 minutes if there is no improvement in the patient’s condition. The service took immediate action and ordered replacement items, including additional adrenaline ampoules and oropharyngeal airways in all sizes. The practice had arrangements with neighbouring businesses to use their Automated External Defibrillators (AED) in the event of a medical emergency and had completed a risk assessment to assess the risk associated with this arrangement. Although the practice could demonstrate that these AEDs could be on site within 3 minutes, the practice had no assurances that these AEDs were in working order. After consideration, the practice decided to rent their own AED and would look to purchase one in the near future. 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, and fire safety equipment was serviced and well maintained. The company who had serviced the fire alarms had identified that one of the detectors needed replacement batteries which had not yet been actioned. The practice assured the inspection team that this would be completed as soon as possible.

The practice ensured equipment was safe to use, 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. The management of fire safety was effective. The practice had arrangements to ensure the safety of the X-ray equipment and the required radiation protection information was available. Improvements were required to ensure the local rules were specific to the environment and not generic, as advised by the service’s Radiation Protection Advisor (RPA). The practice assured the inspection team that the local rules would be updated as soon as possible. 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. Improvements were required to ensure that staff were following the sharp’s policy, as the dental nurse dismantled matrix bands, which can cause a sharps injury . The practice assured us that only clinicians would dismantle matrix bands going forwards, in line with the practice’s sharps policy. The practice had systems for appropriate prescribing of medicines. Improvements were required, as although the prescription pads were stored securely, there were no processes in place to track and monitor their use. Following feedback, the service took immediate action and implemented a log to track the use of the prescription pads and were considering printing out the prescriptions. 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. They were a small team of 3 staff members, and staff told us that worked well for the practice. 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. The dental nurse told us they were encouraged to do further training and to take the lead when appropriate. 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. 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 arrangements to ensure staff training was up-to-date and reviewed at the required intervals. We saw the practice had effective processes to support and develop staff with additional roles and responsibilities.

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 broadly reflected published guidance and the equipment in use was maintained and serviced. Improvements were required to ensure that heavy duty gloves and long handled brushes were replaced regularly, and that the handwashing sink should be separate to the sink where instruments are rinsed. Following feedback, the service immediately implemented a log to track the use of heavy-duty gloves and long handled brushes and introduced a separate bowl for rinsing dental instruments. In addition, the practice did not complete weekly air leakage tests and did not regularly review the data logger for the autoclave. A dental autoclave's air leakage test is a weekly procedure that assesses the autoclave's ability to create a vacuum and remove air from its sterilization chambers. This test, along with regularly reviewing information from the data logger, are vital for quality assurance and helps to identify and fix potential issues early on. The service commenced this testing and review immediately following feedback . Staff demonstrated knowledge and awareness of infection prevention and control processes and we saw single use items were not reprocessed. 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 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.