Great Cornard 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 the safety of the premises and equipment which resulted in a breach of Regulation 12.

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 had completed training in emergency resuscitation and basic life support every year, although not all staff had completed face to face training in emergency resuscitation and basic life support (BLS) as this had been done online. Trainee dental nurses and a receptionist that were new to the practice were yet to undertake training in BLS.

Fire safety management was in place although due to being a new team within the practice not all had yet completed training in fire safety and emergency evacuation of the practice.

Emergency equipment and medicines were available, however checks were not undertaken in accordance with national guidance. Staff could access emergency equipment and medicines in a timely way.

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. However, checks of fire and smoke alarms were not recorded.

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.

Arrangements to ensure the safety of the X-ray equipment and the required radiation protection information was available required improvement. The provider had recently appointed a Radiation Protection Adviser, however servicing of the equipment was overdue. We discussed this with the provider and were advised that this would be put in place.

The practice had risk assessments to minimise the risk that could be caused from substances that are hazardous to health.

Systems to assess, monitor and manage risks to patient and staff safety were not embedded due to recently taking over ownership of the practice. The provider did not have a lone working risk assessment and the sharps safety risk assessment did not reflect current processes within the practice. The practice were using conventional sharps dental items, however there were no needle guards available in treatment rooms.

The practice had some systems for appropriate and safe handling of medicines. We noted local anaesthetics were not stored in blister packs in treatment room drawers. Antimicrobial prescribing audits were not carried out.

Both the dentist and hygienist had completed level 3 vulnerable adults and children safeguarding training. We observed safeguarding information displayed around the practice. However, not all the staff we spoke with were aware of how safeguarding information could be accessed. Staff knew their responsibilities for safeguarding vulnerable adults and children, but not all staff were confident in what action they should take or how.

The provider told us staff received a structured verbal induction programme, which included safeguarding. However, there was no documented evidence to support this process.

The practice had a recruitment policy.

We found that systems to monitor and track the recruitment of staff were ineffective as not all information was available. Disclosure and Barring Service checks were not completed at the correct level for 3 staff members and not completed for 1 staff member. We were not shown evidence of Hepatitis B immunity or a risk assessment for 3 staff members. This meant we were unable to ascertain if the practice was fully implementing its own recruitment policy and meeting these requirements.

Arrangements to ensure staff training was up-to-date and reviewed at the required intervals were not embedded. The practice ensured clinical staff were qualified, registered with the General Dental Council and had appropriate professional indemnity cover. Clinical staff completed continuing professional development required for their registration with the General Dental Council. There was limited evidence of training for reception staff and trainee dental nurses in mental capacity act, basic life support, sepsis, fire safety and disability and autism.

The practice appeared clean and there was an effective schedule in place to ensure it was kept clean. However, there were no records of cleaning schedules across the practice.

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 some infection control procedures which 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. There was scope to ensure testing of the ultrasonic bath was in line with manufacturers guidelines and not all pouched items seen in drawers were dated.

Staff had not completed the appropriate training and infection prevention and control (IPC) audits were not completed.

The practice had some procedures to reduce the risk of Legionella, or other bacteria, developing in water systems, in line with a risk assessment. We noted a risk assessment had been undertaken in May 2022 under the previous provider/service. The dentist confirmed a new risk assessment was scheduled for February 2025. We found temperature checks of hot and cold water outlets were not undertaken and there were no records to evidence temperatures were maintained within recommended guidance. We discussed this with the provider who confirmed these would be put in place.

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.