Claremont Dental Surgery - Wigan

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 they have been put right by the provider. The impact of our concerns, in terms of the safety of clinical care, is minor for patients using the service. Once the shortcomings have been put right the likelihood of them occurring in the future is low. During our assessment of this key question, we found concerns related to the safety of the premises and equipment which resulted in a breach of Regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can find more details of our concerns in the evidence category findings below. Whilst there are issues to be addressed, the impact of our concerns relate to the governance and the 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. 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.

Emergency equipment and medicines were available and checked in accordance with national guidance. Staff could access these in a timely way. The practice was clean. Hazardous substances within the practice were clearly labelled and stored safely. The dental laboratory on the top floor appeared cluttered. We saw satisfactory records of servicing and validation of most equipment in line with manufacturer’s instructions. Fire exits were clear and well signposted, and fire extinguishers were serviced and well maintained. We saw no evidence the firm alarm and emergency lighting were serviced.

The practice ensured most equipment was safe to use and maintained and serviced according to manufacturers’ instructions. A fire safety risk assessment was carried out in line with the legal requirements. The management of fire safety was not effective. We noted there were multiple high risk outstanding actions from the fire risk assessment conducted in 2012 and saw no evidence the fire alarm and emergency lighting were serviced. Following the assessment, we were sent evidence that a new external fire risk assessment had been booked and the fire alarm and emergency lighting would be serviced. On the day, we saw no evidence a gas safety check had been carried out on the boiler. The practice has sent evidence to show this was completed the following day. The practice had arrangements to ensure the safety of the X-ray equipment and the required radiation protection information was available. However, there was an outstanding action from the 3 yearly routine testing for 1 machine yet to be completed. The practice had risk assessments to minimise the risk that could be caused from substances that are hazardous to health. The practice had implemented systems to assess, monitor and manage risks to patient and staff safety. This included sharps safety. The practice had not conducted a lone working risk assessment to assess, monitor and manage risks associated with staff lone working. The practice had systems for appropriate and safe handling of medicines. Antimicrobial prescribing audits were not carried out.

At the time of our inspection, the patients we asked felt there were enough staff working at the practice. They were able to book appointments when needed.

Staff we spoke with had the skills, knowledge and experience to carry out their roles. They told us that there were not sufficient staffing levels. Staff discussed their training needs during ongoing informal discussions. The practice did not routinely conduct practice team meetings and annual appraisals. 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 and procedure to help them employ suitable staff. However, the recruitment policy did not reflect the relevant legislation. The practice assured us this would be addressed and rectified. The practice ensured clinical staff were qualified, registered with the General Dental Council and had appropriate professional indemnity cover. Clinical staff completed continuing professional development required for their registration with the General Dental Council. The practice did not maintain a central log of what training the staff had completed. Some staff members maintained an individual log, but this was not accessible to the practice. We discussed this with staff and was assured this would be addressed and rectified.

Patients told us that the practice looked clean, and equipment appeared to be in a good state of repair.

Staff told us how they ensured the premises and equipment were clean. They demonstrated knowledge and awareness of infection prevention and control processes. Staff told us that single use items were not reprocessed.

The practice appeared clean and there was an effective schedule in place to ensure it was kept clean. Staff followed infection control principles, including the use of personal protective equipment (PPE). Hazardous waste was segregated and disposed of safely. We observed on the day of assessment, the outdoor clinical bin was not locked and was not secured to the premises. We discussed this with staff and were assured this would be addressed and rectified. We observed the decontamination of used dental instruments, which aligned with national guidance.

The practice had infection control procedures which reflected published guidance and the equipment in use. Staff had appropriate training, and the practice completed Infection prevention and control (IPC) audits in line with current guidance. Improvements could be made to the procedures to reduce the risk of Legionella, or other bacteria, developing in water systems, in line with a risk assessment. Monthly hot and cold-water temperature checks were completed and logged. However, those seen were not always within the required temperature ranges and the incorrect sentinel outlets were being tested.

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