Greg Gossayn Dental Surgery

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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. During our assessment of this key question, we found concerns related to the safety of the premises, adequacy and availability of emergency equipment and medicines, recruitment, and the infection prevention and control standards being followed at the practice. This resulted in breaches of Regulations 12 (Safe care and treatment), 17(Good governance), and 19 (Fit and proper persons employed) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can find more details of our concerns in the detailed 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.

The practice did not have effective processes to identify and manage risks. The practice had not carried out a health and safety risk assessment to identify and mitigate specific risks relating to the practice. The practice was not using safer sharps systems and had not completed a risk assessment to assess and mitigate the risks associated with the use of sharps, in line with Health and Safety (Sharp Instruments in Healthcare) Regulations 2013. The practice had not assessed and mitigated the risks associated with lone working. The hygienist worked without chairside support. The inspection team saw not all cleaning products were stored securely, as they could be accessed by patients. The practice’s last Control of Substances Hazardous to Health (COSHH) risk assessments were due to be reviewed in 2015. Not all dental materials and cleaning products had up to date risk assessments or safety data sheets accessible to staff, in line with COSHH regulations 2002. Not all emergency equipment and medicines were available as advised in guidance issued by the Resuscitation Council UK. There was no buccal midazolam which is used to treat prolonged seizures and no spacer device which is used to help administer medicines to treat asthma attacks. In addition, the practice did not have immediate access to an Automated External Defibrillator (AED) to treat sudden cardiac arrest. While there was a verbal agreement in place to use an AED from a neighbouring dental practice, this was not documented within a risk assessment and the practice could not assure themselves that an AED would be on site within 3 minutes. The practice took immediate action and purchased an AED and the missing items from the medical emergency kit following our assessment. Staff knew how to respond to a medical emergency and had completed online training in emergency resuscitation and basic life support every year. Staff did not participate in medical emergency scenario training.

The treatment room and waiting area were visibly clean, despite building works which were ongoing in the basement of the practice. We found the management of fire safety was ineffective. Fire exits were clear and well signposted on the ground floor, but there were no fire exit signs within the basement. A fire risk assessment had last been carried out on 21 July 2016 by an external company. The practice had not completed the actions outlined in this risk assessment. There was no evidence of further fire risk assessments or review of the fire risk assessment since 2016. We saw no evidence that the fire alarm or emergency lighting had been serviced. While we saw evidence that the fire alarms had been tested in-house, this was only recorded yearly. In-house testing of the fire alarms should be recorded weekly, and in-house testing of the emergency lighting should be recorded monthly. We saw no records to demonstrate that staff had performed fire evacuation drills. We saw that fire extinguishers had recently been purchased. We were not assured these fire extinguishers were sufficient in size for the property. We saw combustible materials stored downstairs in the basement, which posed a fire risk. The practice had not had an Electrical Installation Condition Report (EICR), previously known as ‘fixed wiring check’, carried out since 21 April 2012. EICRs are required every 5 years.

We did not see records of servicing and validation of all equipment in line with manufacturer’s instructions. There was no critical examination, acceptance test or recent performance report for the orthopantomogram (OPG), which is a type of x-ray machine. We did not see any local rules for the OPG, which identify key working instruction to ensure that exposure of staff and others to radiation is restricted. The last acceptance test of the intra-oral x-ray unit had been completed in May 2012 and had recommendations which had not been actioned. The intra-oral x-ray unit had been subjected to yearly electromechanical servicing, but we did not see any evidence of any further performance checks, which should be completed every 3 years. In addition, the practice had not notified the Health and Safety Executive that they worked with ionising radiation and had not appointed a Radiation Protection Advisor or Medical Physics Expert. The practice had not carried out a radiation risk assessment.

The practice did not have a recruitment policy and procedures that reflected relevant legislation, to help them employ suitable staff, including agency or locum staff. While the dental nurse had been working at the practice since 2010 and the hygienist had been working at the practice since 2003, we did not see evidence of ongoing monitoring of staff’s fitness to work, including but not limited to; up to date disclosing and barring service checks or evidence of immunity to Hepatitis B, including the level of response (titre levels) for all staff members. The practice frequently used agency nurses who were familiar with the service. We saw no documented evidence that appropriate recruitment checks had been carried out for these agency nurses. The practice did not have an induction checklist or process in place to help new or agency staff with induction. The practice ensured clinical staff were qualified, registered with the General Dental Council and had appropriate professional indemnity cover.

Staff we spoke with had the skills, knowledge and experience to carry out their roles. They 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 some arrangements to ensure staff training, including continuing professional development, was up-to-date and reviewed at the required intervals. The principal dentist referred some implant patients for cone beam computed tomography (CBCT) and interpreted and reported on those scans. We did not see evidence of level 1 core or level 2 training which is required for justification and interpretation of CBCT scans. There were some processes to support and develop staff with additional roles and responsibilities. Staff discussed their learning needs, general wellbeing and aims for future professional development during ongoing informal discussions. Staff stated they felt respected, supported and valued.

Staff had completed appropriate training and demonstrated knowledge and awareness of infection prevention and control processes. Staff confirmed that single use items were not reprocessed, and they used personal protective equipment appropriately. We observed the decontamination of used dental instruments, which did not fully align with national guidance issued by the Department of Health in the publication ‘Health Technical Memorandum 01-05: Decontamination in primary care dental practices’ (HTM01-05). The practice did not monitor the temperature of the water used for manual cleaning of the contaminated dental instruments, to ensure it was below 45 degrees Celsius. There were no systems and processes to monitor the use of heavy-duty gloves or long handled brushes used for manually cleaning the instruments. The vacuum autoclave was stored on a small and cluttered worksurface. We could not be assured that this arrangement provided a dirty to clean flow to avoid cross contamination. There was a risk that the exterior of the pouches could be recontaminated when removing from the autoclave, as there was no suitable area to place these instruments once removed. The equipment used to decontaminate instruments was maintained and serviced as per manufacturers’ instructions.

The practice had protocols to ensure there was safe segregation and disposal of hazardous waste. While the practice appeared clean, environmental cleaning logs had not been completed since 2019, which meant there could be a lack of quality assurance with cleaning of the practice. The practice had completed a Legionella risk assessment in 2012 but had not acted on the recommendations outlined within it. This included annual cleaning and disinfection of the water tank and recording hot and cold-water temperatures on relevant taps. The practice had not completed infection prevention and control (IPC) audits in line with current guidance. This meant the practice did not have suitable processes in place to identify issues and put an action plan in place to address them. The inspection team observed damaged chairs within both treatment rooms, which meant they were not impervious or easily cleanable. The dental chair in the hygienist room had a fabric covering, which could not be cleaned appropriately in between each patient. In addition, local anaesthetic cartridges were not stored in their blister packs, which meant that the cartridges could be exposed to aerosols in the air.

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