Charlbury Dental Practice

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 did not have effective systems to identify, assess and mitigate risks effectively. Actions arising from the three-yearly radiography electrical inspection had not been reviewed or completed. Infection prevention and control audits were not undertaken at the recommended six-monthly intervals and did not include documented action plans. The radiography audit sample size was limited and did not fully reflect the sample size recommended within recognised guidance and the antimicrobial audit lacked a supporting action plan. Arrangements for managing medical emergency medicines were ineffective, as expired midazolam had not been identified, aspirin was not available and a number of items had been removed from their original packaging and stored within pouches; however, pouches were noted to be torn and out-of-date. Risks relating to patients' privacy and dignity within the treatment environment had not been adequately addressed.

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

Staff could access emergency medicines and equipment and had completed annual emergency resuscitation and basic life support training. However, emergency medicines and equipment were not being checked in line with national guidance, reducing assurance that they would be available and ready for use when required.

Staff involved in the care of patients receiving conscious sedation had not completed Immediate Life Support (ILS) training, or equivalent training comprising basic life support, patient assessment, airway management techniques and automated external defibrillator (AED) use. In addition, the practice did not have sufficient knowledge or oversight of the equipment and medicines brought onto the premises by the visiting sedationist. This reduced assurance that appropriate arrangements were in place to identify, assess and manage risks associated with the provision of sedation services.Following the inspection, the provider informed us that they had ceased offering conscious sedation services at the practice.

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 practice had arrangements in place to support the safe use of X-ray equipment, and the required radiation protection information was available. However, recommendations arising from the three-yearly radiography electrical inspection had not been actioned at the time of the inspection. Following the inspection, the provider submitted evidence to demonstrate that the identified actions had since been completed by a qualified electrician.

The practice had arrangements in place to manage fire safety, and fire exits were generally clear and well signposted. However, we observed that a chair had been placed in front of one fire exit, which could have impeded access in the event of an emergency. Following the inspection, the provider provided assurance that the chair had been removed and that the fire exit route was no longer obstructed.

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

The practice had a recruitment policy and procedure to help them employ suitable staff, including agency or locum staff. These reflected the relevant legislation but were not always being followed.

Information relevant to staff employment in their role as required under Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 was not consistently available. For example, satisfactory evidence of conduct in previous employment was not available for 2 staff members and right to work documentation was not seen for 1 clinical member of staff.

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

Newly appointed staff did not always receive an appropriate role specific structured induction.

They 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.

The practice did not have effective arrangements to ensure staff training, including continuing professional development (CPD), was up-to-date and reviewed at the required intervals. Not all clinical and locum staff were able to demonstrate that they had undertaken all CPD relevant to their roles as recommended by the General Dental Council (GDC).

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 supervision, 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 prevention and control procedures that reflected published guidance; however, these were not always followed consistently. At the time of the inspection, routine testing of the ultrasonic baths was not being undertaken. Following the inspection, the provider submitted evidence to demonstrate that these tests are now being completed.

Staff demonstrated knowledge and awareness of infection prevention and control procedures. However, the provider could not demonstrate that all clinical staff had completed appropriate infection prevention and control training, as training records were not available for three of the six clinical staff members reviewed. In addition, there was a lack of effective oversight of surgery cleaning schedules.

Staff used personal protective equipment and decontaminated dental instruments after use, in line with national guidance. 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 practice completed infection prevention and control audits; however, these were not undertaken in line with current guidance, as they were not carried out at the recommended six-monthly frequency.

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