Precious Dental Care

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 and equipment, adequacy and availability of emergency medicines, recruitment, training, support and development of staff, and the infection prevention and control standards being followed, staff understanding, knowledge and awareness of safeguarding and a lack of a learning culture 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 did not identify and manage risks effectively. Staff told us there were issues that had been highlighted to the provider that had not been well managed, and this was reflected in our findings.

The health and safety risk assessment did not highlight risks we observed on the inspection day. We saw damaged cabinetry, a first-floor window which could be opened fully, and lack of lighting and clutter in the cellar, which staff had to enter to access the dental compressor. There was also collapsed cabinetry in one of the surgeries which had been reported but not addressed.

The sharps risk assessment did not include all the devices in use at the practice, and the sharps injury process had not been updated to include the appropriate details for staff to seek further advice and treatment after sharps injuries.

Staff could access emergency equipment and medicines. Staff told us these were checked regularly however checklists were not dated so this could not be verified. We found 2 sets of pads for the automated external defibrillator (AED) which expired in 2021. We were told they became aware of this a month earlier; however, replacements were not ordered until 5 June 2026, and these were not yet available. No action had been taken to consider alternative arrangements.

Emergency adrenaline was available but there were no syringes and needles to administer it in the event of a severe allergic reaction.

Staff had completed training in emergency resuscitation and basic life support. However, this was not effective. Staff could not provide satisfactory responses to questions about what their role would be in the event of a medical emergency arising at the practice. There was evidence of further misunderstanding when we were asked if dental irrigation syringes could be used to administer emergency adrenaline. Dental irrigation syringes are specialised tools used to flush, clean, and disinfect hard-to-reach areas of the mouth.

In response to us highlighting these issues, the provider risk assessed the scheduled patients until the correct needles, syringes and AED pads were obtained. They gave assurance additional training would be undertaken by the team.

Staff we spoke with were aware of the signs and symptoms of sepsis and the action to take if this were suspected.

The premises were visibly dirty, and some areas were poorly maintained and cluttered. Cleaning was not carried out consistently, and there was no evidence of cleaning schedules being completed or monitoring arrangements since 2024.

Hazardous substances were clearly labelled and stored safely. However, systems were not in place to identify and remove expired substances. We found expired dental materials and local anaesthetic cartridges in the surgery drawers. We highlighted safety data sheets and risk assessments should be in place for general cleaning substances.

Records for the servicing of electrical systems and equipment were not always in place. The most recent electrical installation (fixed wiring) inspection was 2016. We saw a burned electrical socket in the decontamination room, which had not been addressed, and no action had been taken to prevent its use. Portable electrical equipment testing had also not been carried out since 2016.

There was no evidence of servicing or pressure vessel testing for the dental compressor. This was scheduled after the inspection. The gas safety certificate from 2026 had the same recommendations as the report in 2024 and there had been no inspection in 2025. There was no evidence of servicing for the air conditioning units and staff confirmed they do not carry out any checks or clean filters.

The sterilisers were routinely serviced and tested appropriately and staff carried out validation checks of this equipment in line with manufacturer’s instructions.

There was evidence of current employer’s liability insurance. We highlighted this should be displayed.

The practice did not have arrangements to ensure the safety of the X-ray equipment and the required radiation protection information was not up-to-date. 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.

Employer’s procedures and local rules were not up-to-date and were not available to operators. The provider did not take appropriate action in response to faults and issues highlighted in performance and electromechanical test reports for an X-ray machine on 4 October 2023 and 20 November 2024 respectively to address the issues and ensure the safety of the equipment in use. We observed the same issues during the inspection; the control panel settings could not be changed to enable the most appropriate dose was used for each exposure.

In response to our findings the provider confirmed and sent evidence this machine had been taken out of use until it is serviced and repaired.

The systems to manage fire safety were ineffective. There was no evidence priority 1 and 2 issues highlighted in the 2009 fire risk assessment were risk assessed or acted upon. These included pressure vessel inspection (PVI) for the compressor, electrical safety testing, the consideration of emergency lighting and highlighted insufficient staff training.

A subsequent internal fire risk assessment had been carried out, but this did not address the recommendations in the previous external risk assessment. In addition, it stated portable appliance testing is carried out at 3-yearly intervals but the last evidence of this was in 2016. The fire alarm system was not subject to servicing to identify any faults. Appropriate fire safety training had not been completed by 6 staff members and evacuation drills were not carried out.

The practice did not have emergency lighting, and there was no evidence to demonstrate that the requirement to illuminate fire escape routes had been assessed in line with recommendations made in the risk assessment from 2009. We were told there were some torches available on the ground floor, but these were not tested. Documentation for the installation of a new powder fire extinguisher stated the risks of a powder device have been explained. However, staff were unaware of the risks of this.

Fire exits were signposted. However, clutter in front of the rear fire door increased the risk of delayed evacuation, or injury during an emergency.

The practice had some systems for appropriate and safe management of medicines. The security of NHS prescription pads and systems to track their use should be reviewed.

The practice had a recruitment policy and procedures that reflected relevant legislation, to help them employ suitable staff. However, this was not followed.

We looked at employment record files for 6 staff members. Of these, 3 had no photographic identification, 1 General Dental Council registration certificate was expired, 5 did not have Disclosure and Barring Service (DBS) carried out before they commenced employment, 1 right to work check had not been made and 1 had expired in 2024.

Evidence of satisfactory employment history was not in place for 3, and professional qualifications were not held for 2. Hepatitis B titre levels were not obtained for 2 members of the clinical staff; and for one of these there was no evidence they had completed the course of vaccinations. Titre levels are required to indicate levels of antibodies following a vaccination to ensure the vaccine has been effective.

Systems were not in place to ensure staff had skills, knowledge and experience to carry out their roles. Some staff did not demonstrate knowledge of safeguarding and did not know how to make a safeguarding referral. They told us they would report any concerns they had to the dentist or practice manager.

The practice did not ensure that staff completed safeguarding training to the appropriate level or updated their training at appropriate intervals. Evidence of staff training was sent to us in response to our inspection findings.

The practice did not ensure staff training, including continuing professional development, was up-to-date and reviewed at the required intervals. We were shown a training tracker which highlighted red crosses indicating where training had not been completed or was overdue for radiation protection, infection prevention and control, fire safety, Legionella awareness, disability and autism, sepsis and Mental Capacity Act. No action had been taken to address this. Evidence that staff were in the process of completing their training was sent to us in response to our inspection findings.

A role specific induction was completed for newly appointed staff.

The practice had an infection control policy that reflected published guidance. However, this was not followed, systems were not in place to identify this.

Staff demonstrated effective processes to decontaminate and sterilise dental instruments and devices after each use. We saw sterilised instruments were visibly clean, pouched and dated to indicate when they needed to be reprocessed in line with national guidance. Staff used personal protective equipment and we saw, and staff confirmed that single-use items were not reprocessed.

However, the decontamination room environment including walls, floors, the extractor fan, clinical cupboards and worksurfaces in the decontamination room were visibly dirty. We saw dirty sticky tape residue on the clinical worksurface in the designated clean area. Some clinical cabinet doors were damaged and hanging off, and pouches of sterilised instruments were stored on bare wood shelves which could not be cleaned effectively. In response to our findings, the manager sent evidence the decontamination room had been cleaned and cleared of inappropriate items.

The decontamination room and surfaces contained inappropriate items which were not relevant to the decontamination process. For example, salt for the car park, boxes and equipment which staff told us was no longer in use. This resulted in a lack of space for staff to process instruments and maintain cleanliness effectively, inhibiting them from following decontamination processes.

When these concerns were brought to the attention of staff, they did not show understanding of the risks of not maintaining a clean environment.

Based on the findings above, we identified gaps in staff knowledge and understanding of the relevant guidance. Additionally, there were no records available to demonstrate that 4 clinical staff members involved in decontamination processes had received appropriate and up-to-date training.

The practice did not have effective procedures to reduce the risk of Legionella, or other bacteria, developing in water systems, in line with a risk assessment and current guidance.

Risk assessments were carried out in 2018 and 2020, the same recommended actions which included implementing a control and management programme, ensuring all appointed staff are adequately trained, checking flexible hoses, insulation of exposed pipework, descaling all tap outlets and removal of pipe dead-legs were highlighted in both these reports and there was no evidence these had been acted on.

Dental unit waterline disinfectant was not used in line with the manufacturer’s instructions, and we saw some evidence of residue on the inside surface of one of the bottles which highlighted this may be ineffective. We discussed this with the manager to identify if a shock treatment was indicated. Staff carried out and logged monthly hot and cold-water temperature testing which showed water temperatures were in the accepted range.

Decontamination equipment was maintained and serviced in line with manufacturers’ instructions. However, we were told that data was never retrieved from either of the 2 autoclave data loggers to ensure there was evidence of consistent complete sterilisation cycles.

The practice completed infection prevention and control audits in line with current guidance. However, systems to audit standards of cleanliness and infection prevention and control were ineffective as they failed to identify the issues highlighted during the inspection. Questions had also been answered incorrectly. For example, that computer keyboards in clinical rooms were covered when they were not. Opportunities to identify and act on concerns were missed.

The practice had protocols to ensure 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.