National Dental Also known as National Dental and Implant Centre Limited

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 equipment and medicines, recruitment, and training, support and development of staff, and the infection prevention and control standards being followed at the practice.

These concerns were in breach of Regulations 12 and 17 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 had ineffective processes to identify and manage risks. A sharps risk assessment had been carried out but was not reflective of practice. For example, the risk assessment did not refer to traditional needles being in use and needle guards were not available for the traditional needles. A fire risk assessment had been carried out but the recommendations within this had not been completed, and it had not been reviewed since creation.

The management of fire safety was ineffective. We did not see documentary evidence of the servicing of the emergency lighting or fire equipment, and there were gaps in servicing records of the fire extinguishers. In addition, we were not assured that the Electrical Installation Condition Report (EICR) evidenced that the condition of the fixed wiring installation in the entire building had been adequately tested or assessed.

Emergency equipment and medicines were not all available and were not checked in accordance with national guidance. For example, out of date medicines and equipment had not been disposed of, and in date ones were not always available. The automated external defibrillator (AED) did not have child pads available, and the adult pads were out of date. In addition, the battery was not inserted ready for use. Since the inspection, we have received evidence that the adult pads for the AED are now available and other medicines have been ordered, but we have not seen evidence that all of these are available in practice.

Staff could access the equipment and medicines in a timely way but did not know how to respond to a medical emergency and had not completed training in emergency resuscitation and basic life support.

The premises were not all visibly clean, well maintained or free from clutter. There was evidence of a persistent damp issue, peeling wallpaper and paint in various areas within the practice. In addition, we saw clutter and rubbish, including expired equipment in the decontamination room, staff areas and the basement. The floor to wall seals in the decontamination room were not intact, and there was exposed electrical cabling and wires in the room.

We did not see satisfactory records of servicing and validation of equipment in line with manufacturer’s instructions. The electrical installation condition report (EICR) dated 29 April 2024, stated “30% of the fixed wiring installation was checked”. We did not see service records for the compressor and the autoclave had not been serviced since 20 December 2023. Following the inspection, we received information that the autoclave servicing had been arranged but have not seen that this has been completed.

The practice did not have effective arrangements to ensure the safety of the X-ray equipment. Evidence of electromechanical servicing was not available for either of the X-ray units and 1 unit had not had the 3-yearly performance check. The required radiation protection information was however available.

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.

Hazardous substances were clearly labelled and stored safely but did not all have appropriate risk assessments or safety data sheets accessible to staff, in line with Control of Substances Hazardous to Health (COSHH) regulations 2002.

The practice had a recruitment policy and procedures to help them employ suitable staff, including agency or locum staff. These reflected 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 always available. For example, a Disclosure and Barring Service (DBS) check, and evidence of Hepatitis B immunity (titre levels) was not available for 2 staff members and there was no risk assessment in place. Satisfactory evidence of conduct in previous employment was not seen for 3 staff and evidence of enrolment on an accredited training course was not seen for trainee staff. In addition, there was no documentary evidence of the named GDC registered supervisor for trainees.

Newly appointed staff had not all had an appropriate role specific structured induction.

Staff we spoke with could not demonstrate they had the skills, knowledge and experience to carry out their roles. There was not always enough staff on duty.

The practice did not have 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 topics: fire safety, safeguarding adults and children, medical emergencies, infection, prevention and control (IPC), Interacting with People with a Learning Disability and Autistic People, Legionella, legal and ethical, Mental Capacity Act, Sepsis and complaints handling. Following the inspection, the provider told us they have plans to complete the outstanding training and have engaged an external provider to support this.

Staff demonstrated knowledge of safeguarding but were not aware of how safeguarding information could be accessed. Staff knew how to escalate safeguarding concerns within the practice but did not have current information on how to escalate concerns externally.

There were ineffective processes to support and develop staff with additional roles and responsibilities. One staff member informed us they had discussed their learning needs, general wellbeing and aims for future professional development during an appraisal, but we did not see written evidence, and we were not told that any other staff had done this.

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

The practice had infection control procedures that reflected published guidance, but these were not always being followed.

Staff were aware of infection prevention and control processes but had not received appropriate training and could not demonstrate knowledge of these.

We observed use of personal protective equipment and the decontamination of used dental instruments, which did not wholly align with national guidance. For example, a thermometer was not used to ensure water used for manual cleaning was within the appropriate range; a pre-enzymatic solution was in use but was not being measured to ensure correct dilution; the disinfectant used for cleaning dental unit water lines (DUWLs) was out of date, and the equipment used in the decontamination process was overloaded.

In addition, we did not see records to demonstrate that weekly and daily testing on the equipment were being completed in line with manufacturer’s instructions or current guidance. Instruments including X-ray holders, hand scalers and burs, kept in clinical areas, were not always pouched and some were pouched but undated.

The practice had ineffective procedures to reduce the risk of Legionella, or other bacteria, developing in water systems. A risk assessment had been completed in line with current guidance, but the recommended actions and control measures were not actioned. For example,

water temperatures were consistently recorded outside of the stated range, and no action had been taken to address this. In addition, the risk assessment had a recommended review date of 04 March 2021 but had not been reviewed.

The practice had protocols to ensure effective cleaning and safe segregation and disposal of hazardous waste, but these were not always being followed. For example, there was no clinical waste bin in the decontamination room, the blind was visibly contaminated with dirt and mould, and the cleaning schedules did not contain sufficient detail to ensure the practice was kept clean.

The practice completed infection prevention and control (IPC) audits, but these were not reflective of practice or in line with current guidance. For example, audits were not completed at recommended intervals and did not identify the gaps found in the decontamination and IPC processes.

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