Octagon Dental care

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 carein accordance withthe relevant regulations. We will be following up on our concerns to ensure the providerhas made the required improvements.

During our inspection of this key question, we found concerns related to thesafety of the premises with regards to fire and Legionella, staff training, support and development of staff, particularly around medical emergencies,and the infection prevention and control standards being followed at the practice.

These concerns were in breach of regulation 12, safe care and treatment 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 systems to identify and manage risks.

Staff could access emergency equipment and medicines; however, these were not checked in line with guidance and had not identified out of date or missing items. The Automated External Defibrillator (AED) was not rescue ready and the pads for the AED had expired in 2018. The provider had not ensured that all staff were competent and skilled in relation to the management of medical emergencies. Daily monitoring and logging of fridge temperatures for storing Glucagon, the medicine used to treat low blood sugar levels, were not completed consistently and the thermometer was not fit for purpose.

Following the inspection and in response to our feedback, the provider submitted evidence that staff had completed training in medical emergencies and the AED and thermometer had been replaced. However, concerns remain around systems in place to ensure that checks of the medical emergency equipment and drugs are completed in line with guidance, staff are undertaking appropriate, regular training and for the oversight of medical emergencies.

The management of fire safety was not effective. A fire risk assessment had been completed by a person who could not demonstrate they had the skills, competence, knowledge and experience to do so. The risk assessment had not suitably identified all risks within the building. Staff demonstrated a lack of understanding of fire safety and there were no records to confirm that annual fire evacuation drills had been carried out. Following the inspection, we saw evidence that a fire risk assessment by a competent person had been arranged, and emergency lighting had been purchased but not yet installed.

The risks associated with the use of sharp instruments were not always managed effectively. We saw that sharps containers were not always disposed of in a timely manner and the sharps risk assessment was not reflective of practice. Following the inspection, we were told that sharps containers were replaced where appropriate.

The practice had arrangements to ensure the safety of the X-ray equipment and most of the required radiation protection information was available. We did not see evidence of Health and Safety Executive Radiation Registration.

We saw areas of the premises which were dusty, cluttered and some surfaces which were not impervious or intact. There were areas of significant wear and tear. Not all sinks were clean or in working order.

Hazardous substances were clearly labelled and stored safely although information for staff to refer to in the event of an emergency was not accessible.

We saw that records of servicing and validation of equipment were not always available, for example there was no evidence to demonstrate that the compressor and ultrasonic bath were maintained in line with manufacturers guidelines.

The practice had systems for appropriate and safe management of medicines.

The practice had a recruitment policy and procedures to help them employ suitable staff, including agency or locum staff. However, this did not wholly reflect relevant legislation. For example, evidence of Hepatitis B immunity (titre levels) was not available for 2 staff members and there were no risk assessments in place. There was a lack of oversight of processes to ensure safe recruitment.

The practice ensured clinical staff were qualified, registered with the General Dental Council and had appropriate professional indemnity cover.

Newly appointed staff did not always have an appropriate role specific structured induction.

The practice had not ensured ongoing staff training, including appropriate continuing professional development (CPD), was kept up-to-date and reviewed at the required intervals. Not all staff had completed training in mandatory and recommended topics for their ongoing registration with the General Dental Council (GDC). For example, safeguarding training appropriate to their role and Learning Disability and Autism training had not been completed.Following the inspection, we were sent evidence to demonstrate that training in some topics had been undertaken.

Staff told us they felt respected, supported and valued.

The practice had infection control procedures, although these did not wholly reflect published guidance.

The practice did not have effective procedures to reduce the risk of Legionella, or other bacteria, developing in water systems. A risk assessment in line with current guidance was not available to evidence that the associated risks had been assessed, or that appropriate control measures and recommendations were in place. We did not see evidence to demonstrate that air-conditioning units were serviced. Following the inspection, we were told that a Legionella risk assessment would be completed.

The practice had cleaning schedules which were not wholly effective. Improvements were needed to the practice's waste handling protocols to ensure waste is segregated and disposed of in compliance with the relevant regulations, in particular Gypsum waste.

Staff were aware of infection prevention and control processes and had received training, but gaps were identified in their knowledge.

Staff used personal protective equipment and decontaminated dental instruments after use, in line with national guidance. However, improvements were required to ensure that heavy duty gloves were changed in line with guidance, and that staff were aware of all validation requirements for the sterilisation equipment. We saw, and staff confirmed that single-use items were not reprocessed.

Audits of infection prevention and control were not reflective of the practice or completed in line with current guidance.

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