Premium 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 providing safe care in accordance with the relevant regulations and had taken into consideration appropriate guidance. Whilst there are issues to be addressed, the impact of our concerns relates to the governance and the oversight of the risks, rather than a patient safety risk. The impact of our concerns, in terms of the safety of clinical care, is minor for patients using the service.

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.

A fire risk assessment was carried out in line with legal requirements on 29 September 2022. However, the management of fire safety was not always effective. The risk assessment highlighted high and medium risk hazards that the provider had not actioned within the required timeframes. At the time of our assessment, there were some actions that remained outstanding. Whilst fire exits were clearly signposted, the rear fire exit was obstructed, and staff did not know how to operate the new fire alarm system. In response to our assessment feedback, the provider told us staff would receive training on how to operate the new system, and all actions listed in their fire risk assessment will be completed. On the day of assessment, not all medical emergency equipment and medicines were available in accordance with national guidance. The practice did not have oral glucose, portable suction or repeat doses of adrenaline for children and adults. Glucagon (the emergency medicine used to treat severe low blood sugar) was stored in the fridge, but the fridge temperature was not monitored to ensure it was stored according to manufacturer’s guidance. The practice did have a weekly checklist for the medical emergency drugs in line with current guidance, but this did not include checks of the medical emergency equipment. Following the assessment, the provider submitted evidence that confirmed they had ordered the missing medical emergency items and will implement the fridge temperature log immediately. Hazardous substances were clearly labelled and stored safely. The practice had risk assessments to minimise the risk that could be caused from substances that are hazardous to health. We saw satisfactory records of servicing and validation of equipment in line with manufacturer’s instructions.

The practice ensured the facilities were maintained in accordance with regulations. The practice had systems for appropriate and safe handling of medicines. Antimicrobial prescribing audits were carried out. The practice had arrangements to ensure the safety of the X-ray equipment and the required radiation protection information was available. Improvements could be made to ensure the practice used rectangular collimators on the intraoral X-ray units, in line with the recommendations made in the most recent 3-yearly performance report. The sharps risk assessment was not reflective of the arrangements within the practice. In addition, we noted that the sharps bin in Surgery 2 was not labelled, and the sharps injury procedure displayed in the staff room and in the policy, folder included inconsistent information. The practice did not have a lone worker risk assessment to identify the risks associated with lone working and the suitable control measures.

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. Staff discussed their training needs during annual appraisals, 1-to-1 meetings, 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. Improvements could be made to ensure safeguarding information displayed in the staff room contained up-to-date information.

The practice had a recruitment policy and procedure to help them employ suitable staff, including for agency or locum staff. These broadly reflected the relevant legislation. Improvements could be made to ensure recruitment checks included evidence of conduct in previous employment and a full employment history. Disclosure and Barring Service (DBS) checks had been obtained at the point of employment for staff in 2011. However, there were no risk assessments to support the decision not to renew a DBS check. The practice did not have arrangements to ensure staff training was up-to-date and reviewed at the required intervals. Not all members of staff completed training in autism and learning disability awareness, fire safety, legionella, sepsis awareness, infection prevention and control and the Mental Capacity Act 2005. In response to our assessment feedback the provider told us that they would be implementing a system to monitor continuous professional development (CPD) and ensure all staff completed training relevant to their role. We saw the practice induction schedule and noted that it did not cover safeguarding, medical emergencies and health and safety. We discussed with the provider the importance of covering these topics as part of their structured induction programme. The practice ensured clinical staff were qualified, registered with the General Dental Council and had appropriate professional indemnity cover.

We were not assured that the practice had an effective system in place to ensure clinical areas were kept clean. We observed a high level of dust, visibly dirty drawers containing dental instruments and cluttered worktops in Surgery 2. In addition, we saw rips in the dental chairs and noted that not all surfaces in the clinical area were impervious and easily cleanable. In their response to our assessment feedback, the provider told us that the high level of dust was mostly caused by the works they were having done prior to the assessment.

The practice had policies and procedures in place to ensure clinical waste was segregated and stored appropriately in line with guidance. We observed the decontamination of used dental instruments, which did not fully align with national guidance. There was no clear dirty to clean flow in the decontamination room and we observed multiple cross contamination of surfaces during the decontamination process. Decontamination of used dental instruments was not always in accordance with recognised guidance. The practice did not have effective systems in place to ensure that unwrapped instruments stored in the clinical area were reprocessed at the end of the day according to the national guidance. In addition, we noted that many instruments were kept in a cluttered box, making the retrieval of instruments, without contaminating others, difficult.

The practice infection prevention policy contained in the policy folder was a template and did not include the details of the decontamination procedures specific to the practice. In addition, the policy referred to the previous owner, as the person responsible to maintain the waste consignment notes. We noted that the current owner took over the practice in 2011. Not all clinical staff members had completed appropriate IPC training. The practice carried out IPC audits annually, and not bi-annually as per the current guidance. In addition, we noted that the audit was not reflective of our findings on the day of the assessment and was not suitable to drive improvement. For example, it stated that staff received training, sharps containers were labelled, and that dental chairs were free from rips. In addition, the audit template contained out of date information as it referred to 21 and 60 days storage time for wrapped instruments. We were shown the Legionella risk assessment dated 26 August 2022. We noted that not all recommendations made in the Legionella risk assessment had been acted upon within the suggested timeframes. These included Legionella training for the responsible person and deputy, provision of a written scheme of control and annual inspection of the multi-point water heater. In addition, there was no evidence that the risk assessment was being regularly reviewed. The provider told us that monthly checks of the hot and cold-water outlets were being carried out, however there were no records of the measurements to demonstrate that the temperatures were within the required range. Following the assessment the provider submitted records of the monthly temperature checks. In addition, we observed limescale deposits on the taps and on the spittoon in surgery 2.

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