Dental Surgery

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:

Staff’s understanding, knowledge and awareness of safeguarding.

These concerns were in breach of Regulation 13 Safeguarding service users from abuse and improper treatment.

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 provider did not have effective safeguarding processes in place and staff were unaware of their responsibilities for safeguarding vulnerable adults and children.

The safeguarding policy was generic and did not specify local arrangements for safeguarding.

The practice did not ensure that staff completed safeguarding training to the appropriate level or updated their training at appropriate intervals.

Staff did not know how to identify adults and children at risk of significant harm and did not know how to make a safeguarding referral or who to inform if they had concerns.

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 to identify and manage risks. In particular, the risks associated with fire safety, health and safety, stock control, hazardous substances, and staff recruitment.

The practice had ineffective systems to manage fire safety. We noted there was no fire detection and emergency lighting system present within the practice.

The premises had undergone a fire risk assessment in December 2018 which had highlighted urgent actions required. On the day of inspection we noted some of these urgent actions were still outstanding and there was no evidence staff had completed mandatory periodic fire safety awareness training.

In addition, we noted combustible materials were stored next to the compressor and internal monthly visual inspections of the fire extinguishers were not being completed. The provider removed the combustibles immediately when highlighted on the inspection day.

The provider acted urgently to reduce the risk and provided evidence in the days following the inspection that a fire detection and emergency lighting system had been installed and they had begun monthly visual inspections of fire extinguishers.

We were assured by the urgent action taken by the provider to reduce the risk to patients and staff. We will return to check the governance and oversight systems to manage fire safety are effective and embedded at a follow-up inspection.

Improvements were required to the oversight of hazardous substances. We noted control of substances hazardous to health (COSHH) risk assessments had been completed but these were not regularly reviewed and dated. Improvements were required to ensure all safety data sheets were available and substances were used in line with manufacturer’s instructions. In particular, ensuring out-of-date items are disposed of.

Staff could access emergency equipment and medicines that were checked in line with national guidance. They knew how to respond to a medical emergency and had completed training in emergency resuscitation and basic life support. We noted there was no sepsis triage prompts available for staff.

We noted there was no eyewash kit and no bodily fluid spillage kit available. The practice submitted evidence following the inspection these had been purchased.

NHS prescription pads were kept securely. However, improvements should be made to ensure there is a log in place to monitor and track their use.

The practice had arrangements to ensure the safety of the X-ray equipment and most the required radiation protection information was available. We noted there was no evidence the practice was registered with the Health and Safety Executive (HSE) for the operation of X-ray devices. 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.

The premises were visibly clean, well maintained and mostly free from clutter.

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

Improvements were required to ensure the practice had an effective recruitment procedure and appropriate processes for requesting and maintaining information about candidates before they were employed as set out in Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. In particular, ensuring staff have satisfactory immunity to Hepatitis B, have an appropriate disclosure and barring service (DBS) check at the time of recruitment and have appropriate professional indemnity cover.

Improvements were required to the oversight of mandatory staff training, including continuing professional development. We noted multiple mandatory training courses were overdue for staff. The practice acted immediately and sent evidence the staff members had started to complete the overdue training courses.

The practice ensured clinical staff were qualified and registered with the General Dental Council.

Improvements were required to the oversight and governance of infection control. The practice did not have infection control procedures that reflected published guidance. We noted single-use items had been reprocessed, and visibly dirty instruments had been pouched and were available for use. We also noted the expiry dates on some of the pouches exceeded 12-months which was not in line with national guidance.

There were ineffective systems for stock control. In particular, we noted multiple items of out-of-date products and materials which appeared to be in use.

We noted the autoclave was overdue its annual service, pressure vessel inspection and validation. The practice submitted evidence these had been completed in the days following the inspection.

The practice completed infection prevention and control audits. However, these were not reflective of what we found on the inspection day and had no action plan to drive improvement.

The practice had effective procedures to reduce the risk of Legionella, or other bacteria, developing in water systems, in line with a risk assessment and current guidance. We noted Legionella training for the Legionella lead as outlined in the Legionella risk assessment was overdue.

The practice had protocols to ensure effective cleaning and safe segregation and disposal of hazardous waste.

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