Mr Alistair Miller - Bishops Cleeve

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.

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. Three non-clinical staff had not completed training in emergency resuscitation and basic life support in the previous 12 months. We were told that face to face training was booked to take place in October 2024 for all staff. Staff we spoke with told us that equipment and instruments were well maintained and readily available. The provider described the processes they had in place to identify and manage risks. Staff felt confident that risks were managed well at the practice, and the reporting of risks was encouraged.

Emergency medicines were available and checked in accordance with national guidance. Staff could access these in a timely way. We noted that a number of pieces of emergency medical equipment were either missing or out of date. Staff immediately ordered replacements and we were shown evidence to confirm this. Staff assured us they would implement a checking system to prevent this issue from happening again in the future. The premises were 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. Fire exits were clear and well signposted, and fire safety equipment was serviced and well maintained. Improvements could be made to ensure that the general waste bins stored at the side of the building were locked, or tethered to a fixed point, to prevent unauthorised interference and possible arson. We have since received evidence which confirms this shortfall has been addressed.

The practice ensured equipment was safe to use and maintained and serviced according to manufacturers’ instructions. The practice ensured the facilities were maintained in accordance with regulations. A fire safety risk assessment was carried out in line with the legal requirements. The management of fire safety was effective. The practice had arrangements to ensure the required radiation protection information was available. An x-ray machine was situated in an area of the practice which was not monitored by staff. The practice had risk assessments to minimise the risk that could be caused from substances that are hazardous to health. The sanitary bin in the patient toilet was not specific to requirements. Environmental Protection Act 1990 – the “duty of care” policy that employees should not be responsible for the management of this sanitary waste. The practice had implemented systems to assess, monitor and manage risks to patient and staff safety. This included sharps safety, sepsis awareness and lone working. The practice had systems for appropriate and safe handling of medicines. Antimicrobial prescribing audits were carried out.

Staff we spoke with had the skills, knowledge and experience to carry out their roles. They told us that there were sufficient staffing levels. Staff stated they felt respected, supported and valued. They were proud to work in the practice. Staff discussed their training needs during practice team meetings and ongoing informal discussions. They also discussed learning needs, general wellbeing and aims for future professional development. Improvements could be made to ensure an effective process is established for the on-going formal appraisal of all staff at appropriate intervals. Staff we spoke with demonstrated knowledge of safeguarding and were aware of how safeguarding information could be accessed. Staff knew their responsibilities for safeguarding vulnerable adults and children.

The practice had a recruitment policy to help them employ suitable staff. Improvements could be made to the practice's recruitment procedures to ensure accurate, complete and detailed records are maintained for all staff. In particular recording the reason why a new staff member’s previous employment ended and carrying out a health assessment. The practice ensured clinical staff were qualified, registered with the General Dental Council and had appropriate professional indemnity cover. Improvements could be made to ensure that newly appointed staff completed a structured induction. Clinical staff completed continuing professional development required for their registration with the General Dental Council. Improvements could be made to ensure staff training records were reviewed at the required intervals to ensure it was carried out. We found that 14 staff had not carried out fire safety training in the previous 12 months. We were assured that all staff would carry out training as soon as practicably possible. We saw the practice had effective processes to support and develop staff with additional roles and responsibilities.

The practice appeared clean and there was an effective schedule in place to ensure it was kept clean. Improvements could be made to ensure that cleaning equipment was stored separately to reduce the risk of cross contamination. We have since received evidence to which confirms this shortfall is being addressed. Staff generally followed infection control principles, including the use of personal protective equipment (PPE). Improvements could be made to ensure that all clinical staff wear appropriate protective footwear when treating patients. Hazardous waste was segregated and disposed of safely. We observed the decontamination of used dental instruments aligned with national guidance

The practice had infection control procedures which reflected published guidance and the equipment in use was maintained and serviced. Staff demonstrated knowledge and awareness of infection prevention and control processes and we saw single use items were not reprocessed. Staff had appropriate training, and the practice completed infection prevention and control (IPC) audits in line with current guidance. The practice had procedures to reduce the risk of Legionella, or other bacteria, developing in water systems, in line with a risk assessment. The practice had policies and procedures in place to ensure clinical waste was segregated and stored appropriately in line with guidance.

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