Barbara Castle Dental Practice - Harlow

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 most risks effectively and staff described the processes.

Staff could access emergency equipment and medicines that were checked in line with national guidance. Routine checks were ineffective and failed to identify missing emergency equipment, including an AED. Although AEDs were available elsewhere in the building, no risk assessment was in place, and missing items identified during inspection had not been confirmed as ordered post inspection. The practice should improve equipment checks to ensure effectiveness and safety for people using the service. Staff had completed training in emergency resuscitation and basic life support every year.

The premises were visibly clean, and free from clutter. Hazardous substances were clearly labelled and stored safely. There was no Health and Safety risk assessment in place for the practice.

We saw satisfactory records of servicing and validation of equipment in line with manufacturer’s instructions.

The practice arrangements to ensure the safety of the X-ray equipment required strengthening. The 3 yearly routine survey for the cone-beam computed tomography (CBCT), equipment and the X-ray machines in both treatment rooms and the annual electromechanical serving of the X-ray machine in treatment room 2 had not been carried out. The rectangular collimator was missing from treatment room 1. 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.

Processes to manage fire safety were undertaken by the Health Centre landlord, however the practice had no oversight of any risk assessments, fire drills or fire equipment testing. The fire exits were clear and well signposted. However, there were no records to confirm staff had undertaken fire safety training and staff could not confirm when the last fire drill had taken place.

The practice had systems for appropriate and safe management of medicines. NHS prescription pads were kept securely.

The practice had a recruitment policy and procedures that reflected relevant legislation, to help them employ suitable staff. However, we saw that the policy was not always followed, there was no evidence of disclosure and barring checks for 6 staff members. We asked for and were not shown evidence of immunity to Hepatitis B (or an associated risk assessment) for 6 staff members.

The practice manager told us they ensured clinical staff were qualified, registered with the General Dental Council and had appropriate professional indemnity cover. However, we found much of this information was not available for review at the time of our inspection and were informed it had been lost following a recent change of compliance software.

Newly appointed staff did not have an appropriate role specific structured induction. The practice should ensure that this is completed for all newly recruited staff.

Staff 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 did not have a system in place to ensure staff training, including continuing professional development, was up-to-date and reviewed at the required intervals. The practice told us they had this information stored on a compliance system they used previously, however this had been lost after they changed systems. Staff appraisals were not undertaken.

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

The practice had some infection control procedures that reflected 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 told us Legionella risk assessments and other checks were undertaken by the building’s landlords. The practice did not have access to any documented risk assessments or any actions that may have been identified from a Legionella risk assessment. We asked the provider to send us this information, including evidence that actions were taken to reduce the risk and spread of legionella in their part of the service, following the inspection, but we did not receive it.

The practice had protocols to ensure effective cleaning and safe segregation and disposal of hazardous waste. However, there were no bodily fluid spillage kits available in the practice.

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

Infection prevention and control audits were not undertaken in line with current guidance.

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