Dental Care London

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 adequacy and availability of emergency equipment and medicines, sharps safety and the infection prevention and control standards including the control of Legionella followed at the practice.

These concerns were in breach of Regulation 12 (Safe Care and Treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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 have effective systems to identify and manage all risks. We noted that a fire risk assessment and a general health and safety risk assessment had been carried out by an external company, but the risks associated with the use of sharps, sepsis and lone working had not been adequately assessed.

A sharps policy was in place, however the practice continued to use traditional reusable local anaesthetic syringes without a documented risk assessment to justify their ongoing use. In the absence of a risk assessment, there was no assurance that the risks associated with reusable syringes had been adequately identified, evaluated and mitigated.

Contaminated sharps were not dismantled and disposed of by the treating clinician in accordance with published guidance. This increased the risk of sharps injuries and potential exposure to blood-borne pathogens for staff responsible for handling and disposing of the equipment.

There were no needle re-sheathing safety devices available to reduce the risk of sharps injuries during the recapping of local anaesthetic needles. This was not consistent with safer sharps practices and increased the risk of needlestick injuries and potential exposure to blood-borne viruses for staff.

In addition, there was no clear sharps injury procedure in place setting out the actions staff should take following a sharps injury, including how to obtain immediate medical advice and access post-exposure prophylaxis where required. Staff were unable to demonstrate sufficient knowledge of the procedure to follow in the event of a sharps injury. As a result, there was an increased risk of delays in obtaining appropriate treatment, support and follow-up, which could adversely affect staff safety and wellbeing.

The sharps container used for the safe disposal of medical sharps was not labelled or dated, in accordance with the safe sharps management procedures. This meant there was no clear record of when the container had been brought into use. Following our inspection feedback, the provider arranged a full day of training for staff, including the topic of sharps safety.

Sepsis prompts to assist the staff to triage appointments, and patient information posters were not displayed within the practice.

We found that chairside support was always available during clinical sessions. However, when the dentist was not on site, staff could be working alone and there was no lone working risk assessment in place. As a result, the practice had not formally identified, assessed or mitigated the risks associated with lone working, nor established appropriate arrangements to ensure the safety and welfare of staff working alone.

Emergency medicines were available in accordance with national guidance. However, we found that not all emergency equipment as recommended by the Resuscitation Council UK was available or subject to effective checking procedures. In particular, there was no portable suction device and no spacer available to support the administration of salbutamol in the event of an asthma-related medical emergency.

On the day of inspection, the Automated External Defibrillator (AED) was not stored in a state of readiness because the battery was not connected. This meant the device would not be immediately available for use in a medical emergency. We also found that the AED electrode pads had expired in 2021. Although the practice advised that replacement pads had been ordered following the inspection, no evidence had been provided to confirm that they had been received and were in place. We were not assured that the AED was fully operational and ready for use. This could compromise the practice's ability to respond effectively to a cardiac emergency. The system for checking medical emergency drugs and equipment were ineffective, as it had not identified the omissions and deficiencies found during the inspection.

There was no eye wash kit available. Although we requested evidence following the inspection, no evidence has been provided to demonstrate that an eye wash kit has been ordered or supplied. We were therefore not assured that appropriate equipment was available to manage an ocular exposure incident.

We found that only one member of staff had completed accredited hands-on basic life support training. This meant there was insufficient assurance that all staff were adequately trained and prepared to respond appropriately in the event of a medical emergency. Following the inspection, the provider took immediate action to address this concern and arranged for appropriate accredited hands-on life support training to be delivered to staff on 6 July 2026. While this demonstrated a commitment to improvement, at the time of the inspection there was limited assurance that the practice had sufficient numbers of suitably trained staff to respond effectively to a medical emergency.

The premises were well maintained and free from clutter. Hazardous substances were clearly labelled and stored safely. However not all relevant hazardous substances were risk assessed, contrary to the practice policy and the Control of Substances Hazardous to Health Regulations 2002. On the day of inspection, we saw documentation that only autoclave cleaning fluid had been risk assessed. In mitigation, Material safety Data Sheets for hazardous substances were available.

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

The practice did not have adequate arrangements to ensure the safety of the X-ray equipment and not all the required radiation protection information was available. In particular the practice could not evidence registration with the Health and Safety Executive (HSE) for work involving ionising radiation. As a result, we could not be assured that regulatory requirements relating to radiation safety were being met.

We reviewed records relating to the hand-held X-ray unit, which had been installed in October 2023. Although an acceptance test had been completed when the equipment was installed , there was no evidence that a critical examination had been carried out as required. Following the inspection, we requested the missing documentation; however, the information provided did not demonstrate that an appropriate critical examination had taken place.

We saw evidence that a routine performance test had been undertaken in October 2025 and were therefore satisfied that the equipment was safe for use at the time of the inspection. However, there was insufficient evidence to demonstrate that routine testing had been carried out annually in accordance with the recommendations of the Radiation Protection Adviser (RPA).

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.

A Class 4 laser was in use at the practice. We saw that a Laser Protection Advisor had been consulted and that the equipment was calibrated to ensure it was safe to use. However, there were no Local Rules or policy in place setting out how the laser should be used safely at the time of inspection. As a result, we could not be assured that all staff had access to the information and guidance necessary to support the safe operation of the laser or that appropriate governance arrangements were in place to minimise the risk of harm to patients, staff and others.

The practice had some systems in place to reduce the risk of fire. A fire risk assessment had been carried out by a competent person in February 2026 and some medium risks had been identified. We found that the provider had taken steps to address several of the recommendations; however, some actions remained outstanding. In particular, fire doors and a fire alarm system had not been installed at the time of the inspection. Although the provider told us that arrangements had been made to install a fire alarm system, they did not provide evidence to confirm this when requested following the inspection. We also found the emergency lighting was not subject to in house testing and there was insufficient evidence to demonstrate all staff had received fire safety training. As a result, we could not be assured that effective arrangements were in place to manage fire safety risks.

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

The practice did not have a recruitment policy. Recruitment procedures did not reflect relevant legislation, to help employ suitable staff. We reviewed personnel records and found that satisfactory evidence of conduct in previous employment relating to health and social care services, or work with children or vulnerable adults, was not available for all relevant members of staff. In addition, proof of the right to work in the UK was unavailable for one member of staff.

Disclosure and Barring Service (DBS) checks had not been carried out for any employed members of staff. Following the inspection, we were told that DBS checks had been arranged. However, we did not receive evidence to demonstrate that all required recruitment records were available or that effective recruitment procedures were in place.

As a result, we could not be assured that appropriate systems were in place to ensure staff were suitable for their roles.

Records confirming hepatitis B immunity were not available for all clinical members of staff. There were no records of vaccination available for one member of staff, and although there was evidence that vaccinations had taken place for another clinical member of staff, evidence of immunity was lacking as no blood test had been carried out to confirm immunity. The provider was asked to send additional evidence to mitigate our findings, however, no further evidence was provided. As a result, we could not be assured that appropriate arrangements were in place to protect staff and patients from the risks associated with exposure to blood-borne viruses.

Newly appointed staff had role specific induction. However, a lack of knowledge was demonstrated with regard to infection prevention and control, Legionella risks and sharps safety. Induction processes were not documented. We also found evidence that incorrect procedures and processes had been communicated to newly appointed staff. This indicated that induction arrangements were not effective in ensuring staff received accurate information and appropriate training from the outset of their employment.

Staff had some skills, knowledge and experience to carry out their roles. They told us that there were enough staff on duty at all times. They demonstrated some knowledge of safeguarding but were unsure of how safeguarding information could be accessed. There were no flow-charts or prompts to guide staff on how to escalate safeguarding concerns within the practice or external agencies. During discussions, staff were also unfamiliar with the term “Was Not Brought” (WNB) and the associated safeguarding approach used when a dependant person, most commonly a child or vulnerable adult, does not attend an appointment because they have not been brought by a parent, carer or other responsible adult. This approach recognises that non-attendance may be an indicator of neglect or other safeguarding concerns and should prompt consideration of the individual's welfare rather than simply recording the appointment as missed.

Evidence of role-specific training or continuous professional development was not available for all members of staff. Missing training certificates included but were not limited to: evidence of training in safeguarding vulnerable adults and children, medical emergencies, infection prevention and control, fire safety, radiography and interacting with people with a learning disability or autism. Overall, we were not assured that there were effective systems in place to monitor training to ensure that all core and role-specific training had been completed or to enable timely action where training requirements had not been met.

There were no systems in place to ensure staff received regular appraisal of their performance in their role to identify any training, learning and development needs. Following our inspection feedback, the provider made arrangements to reduce clinical sessions to identify and make the required improvements, particularly with regard to staff training.

Staff felt respected, supported and valued, and they were proud to work in the practice. However, there was no whistleblowing policy in place to ensure staff knew how to raise concerns if they felt unable to do so internally.

The practice had infection control procedures that did not reflect published guidance. We found that the decontamination process demonstrated by staff did not fully align with the Department of Health publication ‘Health Technical Memorandum 01-05: Decontamination in primary care dental practices’ (HTM01-05). In particular the decontamination room lacked a dedicated handwashing sink and heavy-duty gloves were not available to protect staff from injury whilst carrying out decontamination duties. The water temperature used during the manual cleaning of dental instruments was not monitored, meaning there was no assurance that cleaning was being carried out within the required temperature range.

A Type N autoclave which is a basic non-vacuum steriliser was in use; however, staff were unaware of this and some inappropriate validation tests were being carried out. Instruments were occasionally pouched before autoclaving despite a Type N autoclave being in use. As wrapped instruments cannot be effectively sterilised in a Type N autoclave, there was no assurance that sterilisation had been achieved.

A single cloth hand towel was being used to dry contaminated instruments prior to autoclaving and was also used to dry sterilised instruments before pouching. Staff advised that this was the only towel available and that it was routinely hung on a radiator between uses. This practice created a substantial risk of cross-contamination between contaminated and sterilised instruments. Additionally, instrument transportation boxes were available, but only the lids were labelled. This could create a risk of confusion and cross-contamination if lids were interchanged between containers.

The work surface on the clean side of the decontamination room was not sealed to the wall and had a sticky residue present. Cupboards above the clean area were also sticky, demonstrating ineffective cleaning practices.

An air polishing tip remained attached to a dental unit rather than being pouched and stored appropriately before use. An air polisher is a handheld device used to spray a jet of compressed air and powder onto the teeth. Staff advised it was fitted at the start of the day and was not routinely reprocessed between uses. We were not assured that the tip was being autoclaved after every use, creating a risk of cross-contamination. Intra-oral radiographic holders were only being disinfected between uses and were not being autoclaved. As these devices come into contact with the oral cavity, effective sterilisation could not be assured.

Staff had not received effective training in infection prevention and control processes. Staff were not aware of the signage to identify items that were single use only.

The practice had ineffective procedures to reduce the risk of Legionella, or other bacteria, developing in water systems. A Legionella risk assessment had been carried out by a competent person in February 2026, and it had identified where some actions were required. The provider had addressed this by commencing water temperature testing and recording the results, however there was no evidence that a written scheme of control had been put in place. Dental unit waterlines (DUWLs) were not maintained. No disinfectant was used within the (DUWLs), contrary to the manufacturer's guidance, increasing the risk of microbial contamination and biofilm formation. The water bottle used to supply the (DUWLs) was not disinfected on a regular basis, increasing the risk of microbial contamination and biofilm formation. The quality of water supplied through the dental unit waterlines (DUWLs) was not tested for harmful bacteria. In addition, the DUWLs had never been subjected to shock treatments to control biofilm and microbial contamination, creating a risk that patients could be exposed to contaminated water.

The practice did not have protocols to ensure effective cleaning. There were no cleaning checklists in place to ensure staff consistently carried out required opening and closing procedures within the treatment room.

We acknowledge that the provider took immediate steps to correct the issues found regarding infection prevention and control and the management of DUWLs, we were yet to see systems to prevent reoccurrence implemented and embedded.

Hazardous waste was safely segregated and disposed of.

Equipment was maintained and serviced in line with manufacturers’ instructions. However, the ultrasonic bath had not undergone the required quarterly ultrasonic activity testing to verify its effectiveness, meaning there was insufficient assurance that the equipment was operating efficiently.

The practice was not completing infection prevention and control (IPC) audits at six-monthly intervals in accordance with current national guidance. Regular IPC audits are an important tool for assessing compliance with infection prevention and control standards, identifying areas for improvement and providing assurance that effective systems are in place to protect patients and staff from the risk of infection.

We reviewed the IPC audit in use and found that it lacked sufficient detail to identify areas for improvement. In addition, the audit had not been completed accurately. Several findings recorded within the audit were inconsistent with our observations and discussions with staff during the inspection. For example, the audit stated that staff were aware of sharps injury procedures and infection prevention and control processes. However, our findings indicated that staff knowledge in these areas was limited. The audit also recorded that dental unit waterlines were appropriately maintained, waterline treatment products were being used correctly and water quality monitoring records were maintained. These statements were not supported by the evidence available at the time of the inspection. The inaccuracies identified within the audit meant that it had failed to identify a number of significant shortcomings in infection prevention and control arrangements.

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