Smile Together Lescudjack (Penzance)

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.

Staff demonstrated an open culture in relation to people’s safety. Staff felt confident that risks were well managed at the practice, and this was reflected in our findings.

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.

The management of fire safety was effective, and fire exits were clear and well signposted.

Medicines were available and checked in accordance with national guidance. Staff could access these in a timely way. Staff knew how to respond to a medical emergency and had completed training in emergency resuscitation and basic life support every year.

Documentation was not available to verify that all staff involved in conscious sedation procedures had the necessary training for their roles or had completed the required mandatory continuing professional development training in sedation. We asked the provider to submitevidence of training certificates after the inspection, however, to date nothing has been received.

Staff providing treatment to patients under sedation had completed immediate life support training.

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

The practice should improve the security of NHS prescription pads by ensuring there are effective systems in place to track and monitor their use. On the day we saw a log was in place but we were not assured that it would identify if a prescription or pad went missing.

Emergency equipment was available but did not include all items to be in line with national guidance. This was rectified on the day and the items ordered.

The practice had systems to identify and manage risks. Improvements could be made to ensure effective systems were in place to confirm all staff had adequate immunity for vaccine preventable infectious diseases, in particular when handling clinical waste.

The practice had a recruitment policy and procedures that reflected relevant legislation, to help them employ suitable staff, including agency or locum staff.

The practice ensured clinical staff were qualified, registered with the General Dental Council and had appropriate professional indemnity cover.

Records were not available to demonstrate all newly appointed staff had received 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 due to the high demand for the service, the practice had an insufficient number of dentists. The provider was actively recruiting additional dentists to work at the practice.

Staff 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. However, documentation was not available to verify that all staff had completed regular refresher training, whether online or in-person.

The practice was unable to demonstrate that they had a reliable system to ensure staff training, including continuing professional development, was current and reviewed at necessary intervals. We reviewed a sample of all staff training records and found some staff had exceeded recommended refresher timescales and some training records were not available for review.

There were processes, including access to an online training package, 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, 1-to-1 meetings, practice team meetings and ongoing informal discussions.

We found concerns relating to the governance, management and oversight of infection, prevention and control instrument decontamination processes; in particular dental equipment was sent to another practice, operated by the provider, for decontamination, and on the day of the inspection, we were not assured that the practice had full oversight of the decontamination process, particularly regarding the validation of equipment and the final stage of instrument handling. Although evidence of appropriate maintenance, servicing, and compliance checks was provided following the inspection, improvement was needed to ensure there was a documented procedure in place that clearly outlines the full decontamination journey — including how instruments are transported and how the practice assures their condition upon return.

We observed use of personal protective equipment. We saw, and staff confirmed that single use items were not reprocessed.

The practice lacked effective oversight of procedures to mitigate the risk of Legionella or other bacteria developing in water systems, as per the risk assessment and current guidelines. While water temperature checks were conducted in other parts of the building, they did not cover areas within the dental practice and did not ensure hot water is stored at least 60°C and distributed at 55°C within one minute at outlets, while cold water should be below 20°C.Additionally, the practice did not possess the equipment necessary to perform its own water temperature checks.

The equipment in use was maintained and serviced as per manufacturers’ instructions.

Staff demonstrated knowledge and awareness of infection prevention and control processes. However, the systems did not provide evidence that all clinical staff were completing the recommended annual infection prevention and control training necessary for their roles.

The practice had protocols to ensure effective cleaning but improvements should be made to the arrangements for segregating and disposing of hazardous waste to ensure it is consistently stored safely and securely.

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