Amsel & Wilkins

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.

Although 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.

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 had ineffective processes to identify and manage risks effectively. A health and safety risk assessment was not available, and improvements were required to ensure that all appropriate risk assessments and policies were consistently up to date and accurately reflected current practice.

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 equipment and medicines that were checked in line with national guidance. They knew how to respond to a medical emergency and had completed training in emergency resuscitation and basic life support every year.

Staff also participated in medical emergency scenario training during team meetings.

The premises were visibly clean, well maintained, and free from clutter. However, the clinical flooring in 3 treatment rooms did not meet required infection control standards, as were not fully sealed or coved. We observed large, visible cracks along the coving in 2 surgeries, and in 1 surgery the flooring was not coved to the wall, limiting the ability to ensure effective and thorough cleaning.

Hazardous substances were clearly labelled and stored safely.

We saw satisfactory records of servicing and validation of equipment in line with the manufacturer’s instructions; however, there was an exception relating to one washer disinfector. Following the inspection, we received evidence that this has since been appropriately serviced.

The practice had arrangements to ensure the safety of the X-ray equipment and the required radiation protection information was available. This included handheld X-ray equipment.

The management of fire safety was ineffective. We did not see documentary evidence to demonstrate that routine checks of fire equipment were being carried out. Fire exits were clear and well signposted.

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. 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, evidence of Hepatitis B immunity (titre levels) was not available for 1 clinical staff member and there was no risk assessment in place; satisfactory evidence of conduct in previous employment was not available for 1 staff member; evidence of an appropriate role specific structured induction was not available for 6 members of staff and satisfactory information about any mental health conditions was not available for any staff.

There were ineffective 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 informal discussions, although these were not documented.

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

Staff had the skills, knowledge and experience to carry out their roles. 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 staff were able to demonstrate that they had undertaken all CPD relevant to their roles as recommended by the General Dental Council (GDC).

We saw gaps in the following mandatory and recommended topics: fire safety, safeguarding adults and children, Interacting with People with a Learning Disability and Autistic People and radiography.

Staff felt respected, supported and valued, and they were proud to work in the practice.

The practice had infection control procedures in place; however, these did not fully reflect published guidance and were not always adhered to. For example, there was no mechanical ventilation in the decontamination room to control airflow, with reliance instead placed on open windows and portable fans.

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 in place to reduce the risk of Legionella or other bacteria developing in water systems, in line with a risk assessment and current guidance. However, although a Legionella risk assessment had been completed and identified actions, the provider was unable to demonstrate that these actions had been carried out to support improvement. Evidence provided after the inspection showed that actions and completion dates had been added to the action plan. One action related to ensuring outlets were cleaned and descaled regularly; this was recorded as complete and scheduled to be carried out every 12 weeks. However, during the inspection we observed a significant build-up of limescale on the tap in the patient toilet, indicating this process had not been effectively implemented at that time.

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 in line with current guidance; however, it was unable to demonstrate that actions had been taken to support improvement.

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