Ballard and Tucker Limited

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 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 identified and managed some risks and staff described the processes. We saw that the sharps risk assessment was not always being followed by staff.

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. Staff providing treatment to patients under sedation had also completed immediate life support training.

The premises were visibly clean, well maintained and free from clutter. Hazardous substances were clearly labelled and stored safely. We saw that safety data sheets and risk assessments were available for hazardous substances kept in the practice.

We saw satisfactory records of servicing and validation of most equipment in line with manufacturer’s instructions. However, we saw that whilst all 3 compressors (a machine designed to provide compressed air to power dental instruments) had been serviced, there was no associated Pressure Vessel Inspection (PVI) certification which is a mandatory legal requirement under the Pressure Systems Safety Regulations 2000 (PSSR 2000).

We saw that there were 3 autoclaves (a device used to sterilise equipment and tools using steam at high temperature and pressure) in the practice. Service certificates were available for 2, but 1 had no PVI certification. The third autoclave was a loan machine with no service or PVI certification, so the practice could not be assured it was safe for use. Following feedback, the loan autoclave was removed and the repaired original returned. We saw that this returned autoclave had been serviced but again, there was no PVI certification.

The practice had arrangements to ensure the safety of the X-ray equipment and the required radiation protection information was available. However, we saw that the recommended actions from the last radiation protection report had not been carried out. 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.

We saw that the management of fire safety was ineffective. A fire risk assessment completed in November 2023 identified numerous required actions (including 5 Priority A and 26 Priority B actions), none of which were documented as completed, and several (including multiple priority A actions) had not been addressed. The upstairs of the building did not have any fire alarm equipment installed and staff and patients could be unaware of a fire occurring downstairs. The fire alarm had been identified as not working upstairs since 2023 with no action taken. Although the practice recorded regular checks of the fire alarm, smoke alarms and emergency lighting, we saw that there were no smoke alarms or emergency lighting in place. Following this feedback, the practice installed smoke alarms upstairs and some emergency lighting and told us that the other actions would be completed.
 

The practice had a recruitment policy, yet it was unclear and multiple different versions were present. Improvements were required to ensure that a clear policy was implemented and followed as we saw that multiple staff did not have evidence of adequate immunity to Hepatitis B or evidence of conduct in previous employment. Following this feedback, the provider showed us a new recruitment policy and checklist which they told us will be completed in the future.

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 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, but these did not always reflect published guidance.

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.

The practice had ineffective procedures to reduce the risk of Legionella, or other bacteria, developing in water systems. A risk assessment had been completed in January 2024 which identified a Priority 1 action which needed to be completed as soon as reasonably practicable. At the time of our inspection, the action had not been completed. Following this feedback, we saw that an engineer had been booked to carry this out and a new risk assessment was also arranged.

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

The practice completed infection prevention and control audits; however, these were not carried out in line with current guidance as they were being completed annually. Additionally, the audit was not wholly effective as it had not identified that fabric couches were present in 2 of the treatment rooms. The practice told us the audits will be completed every 6 months going forward.
 

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