Archived: The Avenue Dental Practice

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.

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 most risks and staff we spoke with were able to describe these to us. Staff demonstrated an open culture in relation to people’s safety. Staff felt confident that risks were well managed at the practice.

Systems for checking emergency equipment and medicines required strengthening as they had not identified that items of medical emergency kit were missing or out of date. Items that were missing or were found to be out of date were ordered immediately during our inspection. Weekly checklists were implemented following our inspection to ensure all items were present and expiry dates had not been exceeded.

Staff were not recording fridge temperatures to ensure the glucagon (a medicine which helps to raise blood glucose levels) was being stored at a temperature of 2–8°C in line with the manufacturer’s instructions. The provider assured us this matter would be addressed immediately following the inspection.

Staff 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.

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

The practice had arrangements to ensure the safety of the X-ray equipment and the required radiation protection information was available.

Fire exits were clear and well signposted, and an external fire risk assessment was completed in 2021. However, the management and oversight of fire safety required improvement. We were unable to see recent servicing of the fire alarm, emergency lighting or gas boiler. Monthly emergency lighting tests and fire extinguisher checks were not recorded. Following the inspection, the provider confirmed an EICR, servicing of the fire alarm, emergency lighting and gas boiler had been scheduled. We were also provided with assurance that monthly testing of emergency lighting and monthly checks of fire extinguishers would be implemented and recorded.

The practice had systems for the management of medicines. We identified scope for improvement with the management of prescriptions, including tracking of prescription pads. The provider assured us this would be actioned immediately.

The practice had a recruitment policy and procedures that reflected relevant legislation, to help them employ suitable 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.

We identified scope for improvement in ensuring staff training 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 one-to-one meetings, clinical supervision, 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 prevention and control procedures which required strengthening to reflect published guidance, including the use of logs to ensure heavy duty gloves were changed weekly and ensuring vacuum tests were performed on autoclaves. Procedures were put in place immediately to improve processes.

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 procedures to reduce the risk of Legionella, or other bacteria, developing in water systems. However, there was scope to ensure these were undertaken in line with current guidance, including ensuring water temperatures were above the recommended level and documenting flushing of water lines. Procedures were put in place immediately to improve processes.

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 was not completing infection prevention and control audits at the frequency suggested in current guidance. Following this inspection, we were assured that these audits would be carried out at the required 6-monthly frequency.

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