ADVANCE DENTAL CARE

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 accordance with the relevant regulations and had taken into consideration appropriate guidance.

Whilst there are issues to be addressed, the impact of our concerns relates to the governance and oversight of the risks, rather than a patient safety risk.

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.

Staff knew how to respond to a medical emergency and had completed training in emergency resuscitation and basic life support every year.

Emergency equipment and medicines were available and checked in accordance with national guidance, but these checks were ineffective. The battery in the Automated External Defibrillator (AED) was not in situ and the checks had not identified this. An AED is used to treat people experiencing sudden cardiac arrest. In addition, the emergency kit did not contain all items required, as advised in guidance from The Resuscitation Council UK. Following our inspection, the practice provided evidence that these missing items had been purchased, and the inspection team saw that the AED was operational before leaving the practice.

Hazardous substances were clearly labelled and were stored safely. Improvements were required to ensure that risk assessments were undertaken for all hazardous substances used within the practice in accordance with Control of Substances Hazardous to Health Regulations 2002, and all staff have access to the safety data sheets.

We saw satisfactory records of servicing and validation of most equipment in line with manufacturer’s instructions. However, the intra-oral X-ray machines had last had their 3-yearly checks on 20 September 2021 and were 6 months overdue. In addition, there had been no yearly electromechanical checks since this date. The practice had not actioned the recommendations from the last 3-yearly checks. The practice had arranged for servicing of the intra-oral X-ray units and cone beam computed tomography (CBCT) machine, and this was taking place on the day of our inspection.

The management of fire safety was not consistently effective. We saw that fire exits were well signposted. However, on the day of our inspection, one of the fire exits was not clear and unobstructed, and fire doors were propped open. An external fire risk assessment had been completed in 2016. The practice had not actioned all recommendations within the fire risk assessment, and subsequent fire risk assessments completed in-house had not identified and addressed these concerns. Immediately following our inspection, the practice closed fire doors and introduced a log sheet to ensure the fire exits were clear. In addition, the practice arranged for another fire risk assessment to be completed by a competent person.

The practice had systems for appropriate and safe management of medicines. NHS prescription pads were kept securely, and the practice had introduced a log to monitor and track their use.

The practice had some processes to identify and manage risks. However, the practice had not assessed and mitigated the risks associated with the hygienist working without chairside support, and staff were not following the practice’s sharps risk assessment.

The practice had a recruitment policy and procedures which did not fully reflect relevant legislation. The practice had failed to complete right to work checks for staff and there were inconsistencies with Disclosure and Barring Service (DBS) checks for staff. For example, 1 dental nurse/receptionist had only had a basic DBS check instead of the required enhanced DBS check. Following feedback from the inspection team, the practice ensured right to work checks were completed on all staff.

Newly appointed staff had an appropriate role specific structured induction. The practice ensured clinical staff were qualified, registered with the General Dental Council and had appropriate professional indemnity cover.

While the practice had arrangements to ensure staff training, including continuing professional development (CPD), was up-to-date and reviewed at the required intervals for employed staff, they did not monitor training or CPD for the dental clinicians. This meant that the provider could not be assured that the dentists working in the practice were up-to-date with their CPD and had taken steps to comply with General Dental Council (GDC) requirements.

Staff we spoke with had the skills, knowledge and experience to carry out their roles. 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.

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, 1-to-1 meetings and ongoing informal discussions.

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

The practice had infection control procedures that did not fully align with national guidance.

We saw that dental nurses had received appropriate training on infection prevention and control processes. Personal protective equipment was used correctly.

We observed the decontamination of used dental instruments. This did not fully reflect guidance issued in Health Technical Memorandum 01-05 (HTM 01-5). Staff did not measure the detergent used for the decontamination process, so they could not be assured that the required concentration was being used during manual cleaning of the dental instruments. Pouching of dental instruments was inconsistent.

The equipment used for decontaminating dental instruments was serviced as per manufacturers’ instructions. However, the practice only used 1 logbook to record the checks on the 3 autoclaves. It was not clear which autoclave the checks related to, and there was no evidence of weekly air leakage checks for the vacuum autoclave.

There were systems in place to ensure single-use items were not reprocessed. However, improvements were needed to ensure these systems were consistently followed and to ensure all single-use items were disposed of after use.

The practice had procedures to reduce the risk of Legionella, or other bacteria, developing in water systems, in line with current guidance. However, the practice had installed a new treatment room in 2021. We did not see evidence that this structural change was reflected in the practice Legionella risk assessment and written waterline management scheme.

The practice had protocols to ensure effective cleaning. Improvements could be made to introduce cleaning checklists, to aid with the auditing of the effectiveness of the cleaning process.

The practice had processes to ensure the safe segregation and disposal of hazardous waste.

The practice completed infection prevention and control audits in line with current guidance, but these were not completely reflective of the practice. They had not identified slight damage to the dental chair and worktop in one of the treatment rooms, or that there were no processes to ensure the correct concentration of detergent was used during manual cleaning of the dental instruments.

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