Dunedin Clinic

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

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 had processes to identify and manage risks, including for sharps safety, sepsis awareness and lone working. However, improvement was needed to ensure processes were effective.

A fire risk assessment had been carried out by a person who could not demonstrate they had the skills, knowledge and competence to assess the risks associate with fire at the premises. Following the inspection, we received evidence that a fire risk assessment by a suitably qualified external contractor had been arranged.

The practice’s oversight of fire safety management procedures was not effective. Defects identified during servicing of the fire alarm and emergency lighting had not been addressed in a timely manner, and routine checks had not identified action was needed. In addition, the practice’s Electrical Installation Condition Report (EICR) was unsatisfactory, and we did not see evidence that recommended actions had been completed. The provider has since submitted evidence to show these actions are now being addressed.

Staff knew how to respond to a medical emergency and had completed training in emergency resuscitation and basic life support every year. They could access emergency equipment and medicines that were checked in line with national guidance. However, checks had not identified that some medicines were not available in the recommended dosage or formulation. The provider has since submitted evidence to show these items have now been ordered.

The premises were visibly clean, well maintained and free from clutter. Hazardous substances were stored safely however improvement was needed to ensure appropriate signage was available in accordance with national guidance.

We saw satisfactory records of servicing and validation of equipment in line with manufacturer’s instructions for equipment. However, we were unable to see evidence of servicing for the chair lift.

The practice had a recruitment policy and procedures that reflected relevant legislation. However, these were not consistently followed and oversight of recruitment checks required improvement.

For example, evidence of Hepatitis B immunity (titre levels) was not available for 3 staff, and satisfactory evidence of conduct in previous employment was not available for 2 staff. The provider had submitted evidence since the inspection day to show these members of staff have now had a blood test with satisfactory immunity levels.

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, one-to-one meetings, practice team meetings 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.

The practice completed infection prevention and control audits in line with current guidance. However, these were not wholly reflective of current practice. For example, there was no sanitary bin available in the staff toilet, floor seals in 3 out of 4 surgeries were incomplete and the operator chairs were not intact in 2 out of 4 surgeries. This had been identified on the audit but had not been actioned.

The practice had protocols to ensure effective cleaning and safe segregation and disposal of hazardous waste. However, these were not always being followed, for example foot operated bins were not always in use and clinical waste was being decanted prior to disposal. In addition, improvements were needed to the practice’s environmental cleaning schedules to ensure effective cleaning standards were maintained.

The practice had procedures to reduce the risk of Legionella, or other bacteria, developing in water systems, in line with a risk assessment and current guidance. However, there were outstanding actions from the Legionella risk assessment that posed high and moderate risk which had not been 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.

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

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