Aylesbury Dental Health Centre

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 did not have effective systems and processes to identify, assess and manage risks. We identified concerns in relation to the management of emergency medicines and equipment, the security and monitoring of NHS prescription pads, and the storage and oversight of antibiotics. We also identified shortcomings in infection prevention and control arrangements, the storage and management of COSHH substances, fire safety procedures, and the completion and follow-up of radiography and antimicrobial audits.

Staff could access emergency medicines and equipment; however, several items were missing, and checks had not been completed in line with national guidance. This reduced assurance that emergency medicines and equipment would be available and fit for use when required. Staff were able to describe how they would respond to a medical emergency and had completed annual emergency resuscitation and basic life support training. During the inspection, the provider took immediate action to order replacements.

Staff also participated in medical emergency scenario training.

The premises were visibly clean, well maintained and free from clutter. However, hazardous substances were not always clearly labelled or stored safely. Following the inspection, the provider submitted evidence to demonstrate that appropriate labelling and storage arrangements had been put in place.

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.

The practice did not always manage fire safety effectively, as monthly fire extinguisher checks were not consistently recorded. Fire exits were clear and well signposted.

The practice did not have effective systems for the safe and proper management of medicines. Arrangements for the security and monitoring of NHS prescription pads required improvement, as prescription pads were readily accessible and there was no system to record pad allocation or monitor serial numbers to support oversight and prevent misuse. In addition, antibiotics were stored in a manner that made them readily accessible, and there was no stock control system in place to monitor quantities held, usage or expiry dates. The quantity of antibiotics dispensed exceeded that required under current prescribing guidance, and dispensing labels did not contain accurate practice details.

The practice had a recruitment policy and procedures that reflected relevant legislation and were intended to support the recruitment of suitable staff, including agency and locum staff. However, these procedures were not always followed consistently. Staff recruitment records did not contain evidence of health assessments or declarations to demonstrate that individuals were physically and mentally fit to carry out their roles. In addition, we found no evidence that essential pre-employment checks, including DBS checks, General Dental Council (GDC) registration, indemnity arrangements and training records, had been obtained or verified for a locum dental hygienist working at the practice.

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 annual appraisals / one-to-one meetings / during 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 that reflected published guidance; however, these were not followed consistently. We observed a clinician wearing nail varnish and jewellery, which was not in accordance with the practice's policy and reduced assurance that effective hand hygiene and cross-contamination controls were being maintained. We also found multiple instruments within a treatment room that had not been appropriately sterilised and pouched.

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. Decontamination procedures were not always being followed consistently as cleaning solutions used for hand scrubbing and the ultrasonic bath were not measured in accordance with manufacturers' instructions. There was no system to monitor the replacement of heavy-duty gloves, and water temperature checks were not being undertaken as a thermometer was not available. Staff confirmed that single-use items were not reprocessed.

The practice had procedures in place to reduce the risk of Legionella and other waterborne bacteria developing within the water systems, in line with a risk assessment and current guidance. However, we found that there was no hot water available within the practice at the time of the inspection.

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, the audit findings were not reflective of current practice within the service. During the inspection, we identified a number of infection prevention and control concerns that had not been identified through the provider’s own audit processes.

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