Ealing 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 care in accordance with the relevant regulations. We will be following up on our concerns to ensure the provider has made the required improvements.

During our inspection of this key question, we found concerns related to

the safety of the premises and equipment

safe and effective recruitment of staff and staff training

access to restricted areas by patients and the public

the management of medicine prescriptions

These concerns were in breach of Regulation 15, Premises and equipment.

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 identified and managed some risks effectively and staff described the processes. Staff demonstrated an open culture in relation to people’s safety and felt confident that risks were well managed at the practice, however, this was not always reflected in our findings. On the day of inspection, we found ineffective management of fire safety, Legionella, maintenance of electrical equipment and the Control of Substances Hazardous to Health (COSHH).

The management of sharps was mostly effective, however, in one surgery, the sharps bin was on the floor. We discussed moving it to minimise access to patients.

Staff could access emergency equipment and medicines. However, the pads which attached to the Automatic External Defibrillator (AED) had expired and the practice stocked the incorrect type of Midazolam (a medicine to treat epileptic seizures). Both items were ordered on the day of inspection. Checks were carried out in line with national guidance, however they failed to identify the expired medicines and equipment, and oversight required improving.

Staff knew how to respond to a medical emergency and had completed training in emergency resuscitation and basic life support.

Staff also discussed medical emergency scenarios as a practice.

The premises were visibly clean and well maintained. Hazardous substances were clearly labelled however improvements were required to the practice's processes for the storage of substances hazardous to health identified by the Control of Substances Hazardous to Health Regulations 2002. Risk assessments for substances used in the practice, and safety data sheets were not always obtained and stored. We discussed the need for risk assessments and safety data sheets for each substance and were assured this would be addressed.

We did not see satisfactory records of servicing and validation of all equipment in line with manufacturer’s instructions. There was no evidence of an Electrical Installation Condition Report (fixed wiring) or portable appliance testing (PAT) on the day of inspection.

The practice had some arrangements to ensure the safety of the X-ray equipment and the required radiation protection information was available. However, the practice could not provide evidence that the required 3-yearly performance tests had been carried out on 2 out of the 3 x-ray machines. 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.

Fire safety was not effectively managed. Fire exits were clearly signposted however the practice did not have any fire detection equipment in place due to the ongoing renovations. The risk assessment was completed internally by someone without the skills and training to do so. The practice told us they intended to get a new risk assessment once the renovations were complete, however there was no interim risk assessment or mitigation. Staff had not completed fire safety awareness training. Staff told us that fire drills were carried out, but we saw no recorded evidence of this. We were told that fire extinguishers were serviced 6-monthly, however, we did not see service certificates. Internal checks on the fire extinguishers were not documented.

We saw prescriptions were not stored securely or monitored as described in current guidance.

The practice had a recruitment policy and procedures that reflected relevant legislation, to help them employ suitable staff. However, the policy was not always followed. When reviewing staff files, we noted several staff files lacked required pre-employment checks, including Disclosure and Barring Service (DBS) and references. Some clinical staff also had missing Hepatitis B titre levels.

The practice told us they ensured clinical staff were qualified, registered with the General Dental Council and had appropriate professional indemnity cover, however, for most staff these documents were not available.

We saw limited evidence of a 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 provider did not have arrangements to ensure staff training was up-to-date and reviewed at the required intervals.The practice did not have systems in place to ensure clinical staff had completed Continued Professional Development (CPD) as required for their registration with the General Dental Council. Fire safety awareness training was not available on the day of the inspection for any member of staff, and up-to-date safeguarding training was not available for most staff. Training was completed after our inspection and evidence sent to us.

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, 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.

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 management of Legionella was not effective. A risk assessment had been completed by someone who did not have the skills or training to do so. The practice is currently undergoing renovations and staff assured us they will get a new risk assessment by a competent person once the works are complete. Following the inspection, the practice confirmed that a new risk assessment had been carried out by a competent person.

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 completed infection prevention and control audits, however they were not completed at the required 6-monthly interval. We raised this with staff and were assured that this would be addressed.

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