Updated 27 April 2018
Safety systems and processes [including staff recruitment, equipment and premises and radiography (X-rays)].
The practice had clear systems to keep patients safe.
Staff knew their responsibilities if they had concerns about the safety of children, young people and adults who were vulnerable due to their circumstances. The practice had safeguarding policies and procedures to provide staff with information about identifying, reporting and dealing with suspected abuse. We saw evidence that staff received safeguarding training. Staff knew about the signs and symptoms of abuse and neglect and how to report concerns, including notification to the CQC.
There was a system to highlight vulnerable patients on records, for example, children with child protection plans, adults where there were safeguarding concerns, people with a learning disability or a mental health condition, or who required other support such as with mobility or communication.
The practice staff also had a system to identify adults in other vulnerable situations, for example, those who were known to have experienced modern-day slavery or female genital mutilation.
The practice had a whistleblowing policy. Staff told us they felt confident they could raise concerns without fear of recrimination.
The dentists used rubber dams in line with guidance from the British Endodontic Society when providing root canal treatment. In instances where rubber dam was not used, such as refusal by the patient, other methods were used to protect the airway. This was documented in the dental care record and a risk assessment completed. The principal dentist also ensured this was constantly audited to learn and improve from.
The practice had a business continuity plan describing how the practice would deal with events that could disrupt the normal running of the practice.
The practice had a staff recruitment policy and procedure to help them employ suitable staff. These reflected the relevant legislation. The practice also had checks in place for agency and locum staff. We looked at four staff recruitment records. These showed the practice followed their recruitment procedure.
We noted that clinical staff were qualified and registered with the General Dental Council and had professional indemnity cover.
The practice ensured that facilities and equipment were safe and that equipment was maintained according to manufacturers’ instructions, including electrical and gas appliances.
Records showed that emergency lighting, fire detection and firefighting equipment such as smoke detectors and fire extinguishers were regularly tested.
The practice had suitable arrangements to ensure the safety of the X-ray equipment. They met current radiation regulations and had the required information in their radiation protection file.
We saw evidence that the dentists justified, graded and reported on the radiographs they took. The practice carried out radiography audits every year following current guidance and legislation.
Clinical staff completed continuing professional development in respect of dental radiography.
Risks to patients
There were systems to assess, monitor and manage risks to patient safety.
The practice’s health and safety policies, procedures and risk assessments were up to date and reviewed regularly to help manage potential risk. The practice had current employer’s liability insurance.
We looked at the practice’s arrangements for safe dental care and treatment. The staff followed relevant safety regulations when using needles and other sharp dental items. A sharps risk assessment had been undertaken and was updated annually.
The provider had a system in place to ensure clinical staff had received appropriate vaccinations, including the vaccination to protect them against the Hepatitis B virus, and that the effectiveness of the vaccination was checked.
Staff knew how to respond to a medical emergency and completed training in emergency resuscitation and basic life support every year.
Emergency equipment and medicines were available as described in recognised guidance. The automated external defibrillator pads had expired and we brought this to the attention of the principal dentist. They placed an order for this immediately and showed us evidence. Staff kept records of their checks to make sure these were available, within their expiry date, and in working order.
A dental nurse worked with the dentists when they treated patients in line with the GDC Standards for the Dental Team.
The provider had suitable risk assessments to minimise the risk that can be caused from substances that are hazardous to health.
The practice had an infection prevention and control policy and procedures. They followed guidance in The Health Technical Memorandum 01-05: Decontamination in primary care dental practices (HTM01-05) published by the Department of Health. Staff completed infection prevention and control training and received updates as required.
The practice had suitable arrangements for transporting, cleaning, checking, sterilising and storing instruments in line with HTM 01-05. The records showed equipment used by staff for cleaning and sterilising instruments was validated, maintained and used in line with the manufacturers’ guidance.
The practice had in place systems and protocols to ensure that any dental laboratory work was disinfected prior to being sent to a dental laboratory and before the dental laboratory work was fitted in a patient’s mouth.
The practice had procedures to reduce the possibility of Legionella or other bacteria developing in the water systems, in line with a risk assessment. All recommendations had been actioned and records of water testing and dental unit water line management were in place.
We saw cleaning schedules for the premises. The practice was clean when we inspected and patients confirmed that this was usual.
The practice had policies and procedures in place to ensure clinical waste was segregated and stored appropriately in line with guidance.
The practice carried out infection prevention and control audits twice a year. The latest audit showed the practice was meeting the required standards.
Information to deliver safe care and treatment
Staff had the information they needed to deliver safe care and treatment to patients.
We discussed with the dentist how information to deliver safe care and treatment was handled and recorded. We looked at a sample of dental care records to confirm our findings and noted that individual records were written and managed in a way that kept patients safe. Dental care records we saw were accurate, complete, and legible and were kept securely and complied with data protection requirements.
Patient referrals to other service providers contained specific information which allowed appropriate and timely referrals in line with practice protocols and current guidance.
Safe and appropriate use of medicines
The practice had reliable systems for appropriate and safe handling of medicines.
There was a suitable stock control system of medicines which were held on site. This ensured that medicines did not pass their expiry date and enough medicines were available if required.
The practice stored and kept records of NHS prescriptions as described in current guidance.
The dentists were aware of current guidance with regards to prescribing medicines.
Track record on safety
The practice had a good safety record.
There were comprehensive risk assessments in relation to safety issues. The practice monitored and reviewed incidents. This helped it to understand risks and gave a clear, accurate and current picture that led to safety improvements. In the previous 12 months there had been no safety incidents.
Lessons learned and improvements
The practice learned and made improvements when things went wrong.
The staff were aware of the Serious Incident Framework and recorded, responded to and discussed all incidents to reduce risk and support future learning in line with the framework.
There were adequate systems for reviewing and investigating when things went wrong. The practice learned and shared lessons, identified themes and took action to improve safety in the practice. For example, the practice adopted control measures following an accident in which a clinical waste bag fell to ensure it wouldn’t occur again.
There was a system for receiving and acting on safety alerts. The practice learned from external safety events as well as patient and medicine safety alerts.