Archived: Smmmile

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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 line with the relevant regulations and had taken into consideration appropriate guidance.

Although 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.

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 mostly had identified and managed risks effectively and staff described the processes. Staff demonstrated an open culture in relation to people’s safety. They felt confident that risks were well managed at the practice, however this was not reflected in our findings.

Staff could access emergency equipment and medicines that were checked in line with national guidance. They knew how to respond to a medical emergency and had completed training in emergency resuscitation and basic life support every year.

The premises were visibly clean, well maintained and free from clutter. Hazardous substances were clearly labelled and stored safely. The systems to identify and manage risks from hazardous substances was not effective. Risk assessments were generic and not up-to-date with the products in use.

We saw satisfactory records of servicing and validation of most equipment in line with manufacturer’s instructions. However, certain equipment had lapsed servicing and was undertaken after the inspection. Evidence has now been sent through to show this has now been completed.

The practice had some arrangements to ensure the safety of the X-ray equipment and most of the required radiation protection information was available. We noted that the intra-oral X-ray had not undergone a 3-year routine performance testing and there were no employers’ procedures available for people taking X-rays. There was also no service level agreement available for when implant patients were referred to other providers for a Cone Beam Computed Tomography (CBCT) scan. The practice acted immediately and sent evidence following the inspection the service had been booked, and evidence of the service level agreement in place.

We do not assess compliance with the Ionising Radiation regulations 2017 and the Ionising Radiation (Medical Exposure) regulations 2017 but we do request services to provide evidence that demonstrates their compliance to inform our findings.

The management of fire safety was not fully effective. Fire exits were clear and well signposted, but they were not always accessible. This had been identified within the fire risk assessment but had not been addressed at the time of our visit. There was no evidence any fire drills had been undertaken and there were areas within the practice that stored combustible materials. The practice acted immediately and sent evidence following the inspection that works restricting the fire exits had been booked to be undertaken, all the combustible materials had been removed, and a fire drill had been undertaken.

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

The practice had a recruitment policy and procedures that reflected relevant legislation, to help them employ suitable staff, including agency or locum staff.

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

Newly appointed staff had an appropriate role specific structured induction.

Staff had the skills, knowledge and experience to carry out their roles. They told us that there were enough staff on duty at all times. They demonstrated knowledge of safeguarding and were aware of how safeguarding information could be accessed. Staff knew how to escalate safeguarding concerns within the practice and externally.

The practice ensured staff training, including continuing professional development, was up-to-date and reviewed at the required intervals.

There were effective 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 annual appraisals and during clinical supervision, daily huddles and ongoing informal discussions.

Staff felt respected, supported and valued, and they were proud to work in the practice.

The practice had infection control procedures that reflected published guidance. However, we noted some sterilisation equipment used occasionally was not being tested as frequently as outlined in national guidance. We discussed this with the practice who assured us this will be addressed.

Staff received appropriate training and demonstrated knowledge and awareness of infection prevention and control processes.

Staff used personal protective equipment and decontaminated dental instruments after use, in line with national guidance. We saw, and staff confirmed that single-use items were not reprocessed. We highlighted the provider should ensure staff can access occupational health advice and follow-up in the event of a sharps injury and signposted them to resources to support this.

The practice had some procedures to reduce the risk of Legionella, or other bacteria, developing in water systems. However, we noted there were recommendations with the legionella risk assessment that had not been addressed. Water temperatures were reaching above the required level and there was no evidence to show what had been done regarding this. The practice acted immediately and sent evidence following the inspection that a date had been booked in for the recommendations to be completed.

The practice had protocols to ensure effective cleaning and safe segregation and disposal of hazardous waste.

Equipment was maintained and serviced in line with manufacturers’ instructions.

The practice had completed an infection prevention and control audit. However, the practice had not been carrying these out every 6-months in line with nationally recognised guidance.

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