ESTE DENT LIMITED

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:

safe and effective recruitment of staff including immunisation to Hepatitis B

adequacy of staff training

adequacy and availability of emergency equipment and medicines

management of prescriptions

staff’s understanding, knowledge and awareness of safeguarding

lack of a learning culture at the practice

These concerns were in breach of Regulation 17, Good governance.

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 not identified or managed risks effectively including sharps safety and sepsis awareness.

The sharps risk assessment was brief and did not accurately reflective of practice equipment or working practices. There was no formal arrangement in place for occupation health cover to ensure staff could be assessed and treated promptly in the event of a sharps injury.

Sepsis knowledge required improvement as staff did not have sufficient knowledge of the typical symptoms of sepsis.

The health and safety risk assessment did not adequately address the specific risks associated with the dental practice, its equipment, and clinical activities, instead focusing predominantly on risks relating to the building in which the practice was situated.

Not all medical emergency medicines and equipment were available in accordance with the Resuscitation Council (UK) guidance.

Missing items included oromucosal midazolam, an emergency medicine used to treat prolonged seizures, a spacer device for the salbutamol inhaler, and Glucagon, a medication used to treat severe low blood sugar. Some oropharyngeal airways were missing, some clear face masks were missing, and there was no portable suction. Oxygen reservoir and tubing was missing in both adult and paediatric sizes. Aspirin tablets were 75mg rather than the required 300mg. There was no eyewash kit and no first aid kit.

Medical emergency equipment and medicines were shared with another service within the building. Oxygen was stored separately from the remainder of the emergency kit, and the provider was unable to readily identify its location. The dental practice did not maintain adequate oversight of emergency medicines and equipment. Emergency equipment checks were recorded monthly rather than weekly, in line with Resuscitation Council (UK) guidance. In addition, records did not consistently include expiry dates, to ensure timely replacement of medicines and equipment.

Staff told us they would not feel confident responding to a medical emergency and were unsure of how to use emergency equipment and medicines in the kit. Only 1 staff member who worked infrequently at the practice had completed face-to-face training in emergency resuscitation and basic life support. Three staff members had completed online training and there were no current or historic training certificates for the remaining staff member. Medical emergency scenarios were not discussed as a practice to support staff preparedness.

The premises were visibly clean, well maintained and free from clutter. Hazardous substances were clearly labelled and stored safely. However, the practice did not have adequate governance systems to minimise the risk that could be caused from substances that are hazardous to health. In particular, the practice did not have access to safety data sheets and had not completed risk assessments for each hazardous substance used in the practice.

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

The provider did not have employer’s liability insurance and was unaware of what it was or why it was required.

The practice had arrangements to ensure the safety of the X-ray equipment and the required radiation protection information was available. However, the provider was not registered with the Health and Safety Executive (HSE) in accordance with the Ionising Radiations Regulations 2017 (IRR17) requirements. 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 thatdemonstratestheir compliance to inform our findings.

Fire safety was managed by the building’s management team. The provider did not have adequate oversight of the servicing and internal checks completed by the management team and did not routinely ask them for copies of their logs. We saw logs of weekly fire alarm tests between 2023 and November 2025, but the provider had not asked the management team for copies of more recent tests. The provider was unable to tell us how often the emergency lighting and fire extinguishers were checked and had not requested copies of these logs.

We saw fire drill records for 2022 and 2025; however, it was unclear whether staff at the dental practice took part in these drills. The fire risk assessment dated November 2025 highlighted the need to increase the frequency of fire drills in the action plan.

Fire exits were clear and well signposted.

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

The practice had a recruitment policy that reflected relevant legislation; however it was undated, and the policy had not been adhered to when recruiting staff.

The recruitment policy stated that new staff members required an enhanced DBS check and that it would be renewed every 3 years. Only 1 member of staff had a documented Disclosure and Barring Services (DBS) check. The provider told us they did not apply for DBS checks for new staff members and did not ask them whether they had an existing certificate. Hepatitis B titre levels (to indicate antibodies related to the virus) were not obtained at the point of recruitment for clinical staff. Since the inspection, we have seen evidence of blood tests to obtain this information.

Right to Work checks had not been conducted for any staff members. Evidence of satisfactory conduct in previous employment had not been obtained or documented for any staff members, in accordance with Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The provider ensured clinical staff were appropriately qualified and registered with the General Dental Council. Dental professionals are required to maintain appropriate professional indemnity arrangements to provide protection for patients and provide access to compensation. in the event of a clinical negligence claim. The provider was unable to demonstrate that adequate indemnity arrangements were in place for all registered dental professionals.

We did not see evidence that staff had an appropriate role specific structured induction.

Staff demonstrated insufficient knowledge of safeguarding, in particular, the types of abuse and signs and symptoms of abuse. Staff knew how to escalate safeguarding concerns within the practice, however, knowledge of how to escalate externally required improvement. Safeguarding scenarios were not discussed as a team.

The provider did not have oversight of staff training, including continuing professional development. Training was not up-to-date or reviewed at the required intervals. Staff had not completed mandatory topics such as learning disability and autism awareness training. There were no training certificates for 1 clinical staff member. Fire safety awareness had not been completed by 3 out of 5 staff members. Online medical emergencies training had been completed by 3 staff members after the inspection was announced. There were no previous certificates available for review.

Staff felt respected, supported and valued, and they were proud to work in the practice. However, there were no formal processes for staff to discuss their learning needs and aims for future professional development. Staff reported regular informal discussions, but annual appraisals, one-to-one meetings and practice team meetings were not held.

The practice had infection control procedures that mostly reflected published guidance.

Staff received appropriate training and demonstrated knowledge and awareness of infection prevention and control processes.

Not all the required personal protective equipment was available for decontaminating dental instruments. There were no heavy-duty gloves to protect staff from a sharps injury whilst manually scrubbing instruments and the practice did not stock aprons which should be worn during the decontamination process.

The practice had some protocols to ensure effective cleaning and safe segregation and disposal of hazardous waste. However, the practice only had one cleaning mop which was used in both clinical and non-clinical areas contrary to Health Technical Memorandum 01-05: Decontamination in primary care dental practices guidance. This did not support effective measures to prevent cross-contamination.

We observed that not all clinical waste bins were locked or tethered, and they were accessible to members of the public.

We saw, and staff confirmed that single-use items were not reprocessed.

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.

Equipment was maintained and serviced in line with manufacturers’ instructions.

The practice did not complete infection prevention and control audits in line with current guidance. The template was brief and not fit for purpose. It had not highlighted areas of concern we noted on the day of inspection. The audit was not completed 6-monthly in line with guidance and there were no action plans or evidence of shared learning.

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