Overton 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 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; training, support and development of staff; the infection prevention and control standards were not always being followed at the practice.

These concerns were in breach of Regulation 12, Safe Care and 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 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 ineffective processes to identify and manage risks. A sharps risk assessment and a health and safety risk assessment had been carried out but were not sufficiently comprehensive. A fire risk assessment had been carried out by a person who could not demonstrate they had the skills, knowledge and competence to assess the risks associate with fire at the premises. Following the inspection, we received evidence that a fire risk assessment by a suitably qualified external contractor had been arranged.

Staff demonstrated an open culture in relation to people’s safety. They felt confident that risks were well managed at the practice, and this was not wholly reflected in our findings.

The management of fire safety was ineffective. Routine checks of the fire alarm and emergency lighting were not adequately documented or being completed at the appropriate intervals. We did not see documentary evidence of the 6 monthly servicing of the fire alarm. Although Portable appliance testing (PAT) had been completed, the person who carried out the testing could not demonstrate appropriate competence or qualifications. Only a certificate was available, and no accompanying PAT report or test results. As a result, the provider could not evidence that electrical safety checks had been completed correctly or that equipment was safe to use. Fire exits were well signposted, but the fire doors had metal bars across them, impeding evacuation in the event of a fire. Following the inspection, we received evidence that training had been completed in PAT testing, however the training was dated after the date of the testing. The provider has since confirmed PAT testing by a competent person has been arranged.

Staff could access emergency equipment and medicines, but these were not being checked at the appropriate intervals, in line with national guidance. The checklist did not include all of the necessary information and did not identify issues with the available medicines and equipment. Intramuscular Midazolam was available, but not the recommended Buccal (oromucosal) Midazolam and we were not assured staff had the required training in the safe administration of the available medication. In addition, the temperature of the fridge to store Glucagon medication was not being effectively recorded. Immediate action was taken to replace the Midazolam and following the inspection we received confirmation that improvements had been made to the monitoring and recording of fridge temperatures.

Staff knew how to respond to a medical emergency. We noted annual training in emergency resuscitation and basic life support had recently expired. We were told that training was booked for May but had been postponed and rearranged for June.

The premises were visibly clean and well maintained. However, we saw expired equipment in a storeroom which the provider has told us they are arranging collection of. Hazardous substances were clearly labelled and stored safely.

The practice had systems for appropriate and safe management of medicines. However, there was no log available for dispensing of medicines to monitor and track their use, expiry dates and stock control.

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. This included cone-beam computed tomography (CBCT) equipment.

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.

The practice did not have arrangements to ensure staff training, including continuing professional development (CPD), was up-to-date and reviewed at the required intervals. Not all clinical staff were able to demonstrate that they had undertaken all CPD relevant to their roles as recommended by the General Dental Council (GDC). In particular, key safety training including Ionising Radiation (Medical Exposure) Regulations (IR(ME)R), fire safety, medical emergencies, legionella, and sepsis had not been completed. Although dentists had completed CBCT training, this did not include the IR(ME)R‑specific elements required for the justification and safe operation of ionising radiation equipment. Following the inspection, we received confirmation that training had been completed in most topics and plans were in place to complete the outstanding training.

There were effective processes to support staff. They discussed their general wellbeing and aims for future professional development during annual appraisals, practice team meetings and ongoing informal discussions. However, these discussions had not identified the learning needs and gaps in staff training, or their desire to take on additional roles and responsibilities.

Staff felt respected, supported and valued, and they were proud to work in the practice.

The practice had infection control procedures which overall 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 practice had ineffective procedures to reduce the risk of Legionella, or other bacteria, developing in water systems. A risk assessment had been completed, but this was not in line with guidance and had been completed by a person who could not demonstrate they had the skills, knowledge and competence to assess the risks associated with Legionella. The practice could not evidence that the associated risks had been assessed, or that appropriate control measures and recommendations were in place. In addition, we did not see evidence that hot and cold-water temperatures were being monitored or recorded to ensure they remained within an appropriate range. Following the inspection, we received assurance that improvements were underway to the practice’s processes and a risk assessment carried out by an external contractor had been arranged.

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 (IPC) audits, but these were not always reflective of practice or in line with current guidance. Following the inspection, we received assurance that improvements had been made to the carrying out of IPC audits.

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