The Lytham Dental 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

We found this practice was providing safe care in accordance with the relevant regulations and had taken into consideration appropriate guidance.

Whilst 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 some processes to identify and manage risks and staff we spoke with were able to describe these to us.

Emergency equipment and medicines were available and checked in accordance with national guidance. Staff could access these in a timely way. We highlighted the expiry date of an unrefrigerated medicine should be adjusted in line with the manufacturer’s instructions.

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. However, the installation reports for the Dental Cone Beam Computed Tomography (CBCT) included recommendations that had not been acted on. After the inspection, evidence the provider was discussing these with their Radiation Protection Advisor and implementing recommendations was sent to us.

An electrical installation condition report had been carried out in March 2018. This included 6 actions, 3 of which were significant concerns that needs to be addressed quicky to maintain electrical safety. We asked for but were not provided with evidence that these had been addressed as part of the ongoing renovations. After the inspection, the provider contacted their electrical contractors to obtain further missing reports and assurances.

Evidence to show up-to-date servicing and testing of the dental compressors was in place could not be provided. The provider arranged for this to be carried out after the inspection.

The management of fire safety was not effective. A fire risk self-assessment had been completed. However, this was not effective as it did not identify recommendations in a previous electrical safety report from 2018 that additional fire detectors should be installed, and this had not been acted on. On the inspection day we saw the rear door was signed as a fire exit. However, the rear gate to enable escape to the assembly point was blocked by building materials and boxes. These were removed immediately.

The practice had systems for appropriate and safe handling of medicines.

The practice had a recruitment policy and procedures that reflected relevant legislation, to help them employ suitable staff. However, this was not followed. Prior to the inspection, a new manager had reviewed the staff records and identified that Disclosure and Barring Service (DBS) checks had not been carried out or risk assessed for new staff, and they had completed these. However, they had not identified further gaps highlighted by the inspection.

There were no records held for a visiting oral surgeon and limited information for the implant dentist. No satisfactory evidence of previous conduct, such as references had been obtained for new employees.

The practice ensured clinical staff were qualified, but did not have systems to ensure they remained registered with the General Dental Council or had appropriate current professional indemnity cover in place as the certificates held on file had expired. Evidence of appropriate current indemnity was obtained and sent after the inspection. Dental nurses were covered by the principal dentist’s indemnity but were not provided with the details of this cover to assure themselves it was sufficient. The provider confirmed this would be addressed.

Newly appointed staff had an appropriate role specific structured induction.

Staff we spoke with had the skills, knowledge and experience to carry out their roles. They told us that there were sufficient staffing levels. They demonstrated knowledge of safeguarding and who the practice lead was. The safeguarding policy and process should be improved by including information to support the team to identify and quickly act on concerns. We signposted the provider to additional resources to support this.

The practice did not have arrangements to ensure staff training, including continuing professional development, was up-to-date and reviewed at the required intervals. For example, 5 members of staff had not completed safeguarding training, and 12 had not completed infection prevention and control training. This was completed and evidence sent after the inspection.

There were processes to support and develop staff with additional roles and responsibilities. Staff discussed their learning needs and aims for future professional development during annual appraisals, practice team meetings and ongoing informal discussions.

The practice had infection control procedures that reflected published guidance. However, the infection prevention and control processes should be reviewed. Staff were at increased risk of a sharp’s injury using a wire brush to clean instruments, and these cause damage to instruments which makes it more difficult to clean effectively.

We observed use of personal protective equipment and the decontamination of used dental instruments, which aligned with national guidance. We saw, and staff confirmed that single-use items were not reprocessed. Evidence of satisfactory immunisation against Hepatitis B had not been obtained for 3 clinical staff members, and arrangements were not in place to ensure staff could obtain timely advice and assessment in the event of a sharp’s injury.

We were told a Legionella risk assessment had been carried out but evidence of this could not be found. The practice rebooked this. There were procedures to reduce the risk of Legionella, or other bacteria, developing in water systems.

The practice had protocols to ensure effective cleaning and segregation and disposal of hazardous waste. The storage of hazardous waste in a secure cage was not in line with legislation. We signposted the provider to guidance that waste should be stored in fully enclosed, rigid, leak-proof and weatherproof containers.

The equipment in use was maintained and serviced as per manufacturers’ instructions. A procedure had not been in place to ensure staff carried out continuous appropriate validation testing on the ultrasonic cleaner. A trainee dental nurse had realised testing was not being done and reinitiated them.

The practice completed infection prevention and control audits in line with current guidance. However, these had not identified the issues highlighted by the inspection.

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