Markham Associates

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.

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 processes to identify and manage risks, but improvement was needed to ensure processes were effective.

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

Staff could access emergency equipment and medicines, however we did not see evidence that they were checked in line with national guidance. We have since received evidence to confirm that what we had highlighted on our inspection had been addressed.

They knew how to respond to a medical emergency and most staff had completed training in emergency resuscitation and basic life support every year. Staff also participated in medical emergency scenario training.

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

Hazardous substances were not clearly labelled and stored safely. Improvement could be made to ensure the control of substances hazardous to health (COSHH) safety data sheets were stored in an ordered method to enable staff to access information in a timely way.

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.

Improvement was needed to ensure that fire safety management procedures were effective, as we did not see evidence of annual fire safety risk assessments.

Whilst these issues were present, our concerns related to lack of governance and risk oversight, rather than immediate patient and staff safety.

Staff we spoke with had the skills, knowledge and experience to carry out their roles. They told us that there were sufficient levels of 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 had a recruitment policy and procedure to help them employ suitable staff, including for agency or locum staff. These reflected the relevant legislation but were not always being followed.

Recruitment and training records were not available for specialist clinical staff who provided services at the practice on an occasional basis.

The practice did not always ensure clinical staff were qualified, registered with the General Dental Council and had appropriate professional indemnity cover.

The practice should take action to ensure that all clinical staff have adequate immunity for vaccine preventable infectious diseases.

Training was not monitored effectively to ensure staff were up to date with their mandatory training and their continuing professional development (CPD).

Disclosure and Barring Service (DBS) checks were not available for all clinical staff.

Newly appointed staff had an appropriate role specific structured induction.

Staff 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.

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, during clinical supervisions, 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 control procedures that 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 effective procedures to reduce the risk of Legionella, or other bacteria, developing in water systems, in line with a risk assessment and current guidance.

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