Ealing Dental & Medical Stunning Smile Skin Clinic

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. During our assessment of this key question, we found concerns related to the safety of the premises and equipment, recruitment and training of staff, and the infection prevention and control standards being followed at the practice. This resulted in breaches of Regulations 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also found concerns related to the management of people's medicines which resulted in a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Whilst there are issues to be addressed, the impact of our concerns relates to the governance and the oversight of the risks, rather than a patient safety risk. You can find more details of our concerns in the evidence category 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.

Staff knew how to respond to a medical emergency and had completed training in emergency resuscitation and basic life support every year. Staff were encouraged to participate in medical emergency scenario training. 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 well managed at the practice, and the reporting of risks was encouraged.

Emergency equipment and medicines were readily available. We saw records of daily checks of the oxygen cylinder and the automated external defibrillator, but there were no records of checks of the rest of the medical emergency equipment. The paediatric high concentration oxygen mask had been opened and had an expiry date of April 2024. Resuscitation (UK) Council guidance recommends at least weekly checks of all equipment and checking should be the subject of local audit. The premises were clean, well maintained and free from clutter. However, cleaning products were stored within the bathroom and accessible to patients. This was rectified following feedback from the inspection team. The practice was unable to provide evidence of annual servicing and 3-yearly performance checks for the radiography equipment. Five weeks after our onsite inspection, the service provided evidence of critical examination of the cone-beam computed tomography (CBCT ) machine. Evidence of servicing and critical testing should be kept within the radiation protection file. There was no evidence of a risk assessment or local rules for the use of lasers. The practice had not displayed signs to demonstrate that lasers were used at the practice. Fire exits were clear and well signposted. However, 1 set of fire extinguishers were not easily accessible as they were hidden behind a screen. We saw no evidence of annual servicing of the fire alarm, emergency lighting or fire extinguishers. The fire logbook did not have any record of in-house testing of the fire alarm or emergency lighting. There were no records to demonstrate the practice carried out fire drills. Staff did not know if there was a fire blanket on site. The practice was using a water drain connection on the rear of the autoclave to drain hot water directly into the sink where manual cleaning was taking place while the machine was in use. This posed a risk of scalding to staff.

The practice had not ensured the facilities were maintained in accordance with regulations. A fire risk assessment had been completed by an external company on 7 June 2021 which had identified poor cable management and overloading of electrical equipment. We saw evidence of continued poor cable management at the reception desk. In-house fire risk assessments had subsequently been carried out by the principal dentist, who had not recognised that actions from the risk assessment had not been actioned, or testing of the fire safety equipment was not being carried out. The practice did not have robust arrangements to ensure the safe use of X-ray equipment. Radiation protection information was unavailable. The service sent evidence that a Radiation Protection Advisor (RPA) and Medical Physics Expert (MPE) had been appointed on 3 July 2024. The principal dentist was unaware if servicing of radiography equipment was up to date or if a critical examination and acceptance testing had been completed for the CBCT. The practice had risk assessments to minimise the risk that could be caused from substances that are hazardous to health, but staff did not have access to relevant safety data sheets. The practice had implemented systems to assess, monitor and manage risks to patient and staff safety, but these were not always effective. We saw the trainee dental nurse dismantled sharps within the decontamination room, which was not in line with the sharps risk assessment. The practice did not substitute unprotected medical sharps with safer sharps, that incorporated mechanisms to minimise the risk of accidental injury, in line with Health and Safety (Sharps Instruments in Healthcare) Regulation 2013. There was no evidence the trainee dental nurse had immunity to Hepatitis B.

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

Staff stated they felt respected, supported and valued. They were proud to work in the practice. Staff discussed their training needs during 1 to 1 meetings, practice team meetings and ongoing informal discussions. They also discussed learning needs, general wellbeing and aims for future professional development. One staff member told us, ‘My contributions are acknowledged and I receive regular positive feedback. The team is great at supporting each other.’ Staff told us that there were sufficient staffing levels. Staff we spoke with demonstrated knowledge of safeguarding and most staff were aware of how safeguarding information could be accessed. Not all staff knew who the safeguarding lead was. The provider could not demonstrate that all members of staff had received safeguarding training to equip them with the knowledge on how to appropriately report abuse and neglect. They told us they would escalate any safeguarding concerns to the practice principal. Staff told us they had received a structured induction programme.

The practice did not have a recruitment policy and procedure to help them employ suitable staff, including agency or locum staff. On the day of our assessment, a cover nurse was working at the practice who had not been subjected to any recruitment checks to ensure they were suitably qualified to work at the practice. There was no documentary evidence of proof of identity, full employment history or any Disclosing and Barring Service (DBS) checks for this staff member. We did not see evidence of DBS checks for the trainee dental nurse and the DBS check for the dental hygienist was a basic check and not enhanced. Following feedback, the service submitted evidence which showed that the correct level of DBS checks had been applied for. While we saw evidence of immunisation against the Hepatitis B virus, the service did not have any evidence of immunity through titre levels for the trainee dental nurse. Immunity to Hepatitis B is not always achieved following immunisation. The induction checklist did not cover medical emergencies, safeguarding or radiography. The practice ensured clinical staff were qualified, registered with the General Dental Council and had appropriate professional indemnity cover. The practice did not have effective arrangements in place to ensure staff training was up-to-date and reviewed at the required intervals. We did not see any evidence of safeguarding training or training on how to interact with people with a learning difficulty or autism for the trainee dental nurse or the part time receptionist. The Health and Care Act 2022 states that all CQC registered service providers must ensure their staff have training on learning disability and autism that is appropriate to their role.

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 and well maintained. They demonstrated knowledge and awareness of infection prevention and control processes, but there were inconsistencies between the staff members on how they decontaminated dental instruments. Staff told us that single use items were not reprocessed.

The practice appeared clean but there were ineffective schedules in place to ensure it was kept clean. The last completed cleaning schedules were from 2021. We observed the decontamination of used dental instruments. This did not fully align with national guidance. There was no thermometer available to check the water temperature during manual cleaning to ensure the temperature of the water was 45 degrees Celsius or lower. There were no systems in place for monitoring the use of heavy-duty gloves and long handled brushes. We did not see staff wearing the appropriate personal protective equipment (PPE) for decontaminating dental instruments, such as an apron and visor. The ultrasonic bath had not been emptied or cleaned prior to the assessment. We saw debris within the ultrasonic bath. We were told the ultrasonic bath had not been used for several weeks. There were no records kept of validation tests for the ultrasonic bath. Hazardous waste was segregated and disposed of safely. Improvements were required to ensure the clinical waste bag in the decontamination room was supported within a bin, as it was left on the floor which posed a risk to staff when filling up the bag.

The practice had infection control procedures which did not fully reflect published guidance for the equipment in use. We saw evidence of daily testing but no evidence that weekly air leakage tests were carried out on the autoclave. We were told the data logger, which was an internal feature of the autoclave, was not used. This meant there was no assurance on the validation and no recording of the parameters achieved during the sterilisation cycle. The practice completed Infection prevention and control (IPC) audits in line with current guidance, but these did not always drive improvement. The IPC audit completed on 14 February 2024 had identified that the practice did not have records of Hepatitis B immunity for all staff. On the day of our assessment, we were unable to see records of Hepatitis B immunity for the trainee dental nurse, the covering nurse and the lead nurse (who carried out decontamination of dental instruments). The practice did not have effective procedures to reduce the risk of Legionella, or other bacteria, developing in water systems. A Legionella risk assessment had been carried out in house by the principal dentist. Records of water temperature at water outlets were seen on site. They had not identified that the hot and cold temperatures were not in the range recommended in guidance from Health Technical Memorandum 01-05: Decontamination in primary care dental practices, to prevent possible contamination with Legionella bacteria. The practice had policies and procedures in place to ensure clinical waste was segregated and stored appropriately in line with guidance.

We collected feedback from 5 patients. Two of those patients had been prescribed medicines and told us they had been given information on the use, dose and possible side effects of prescribed medicines.

The principal dentist prescribed antibiotics when required to manage infection. Improvements could be made to ensure prescribing was in line with current prescribing guidance from the Faculty of General Dental Practice and the Faculty of Dental Surgery of the Royal College of Surgeons of England, or justification is documented when deviating from this guidance.

The service did not store all medicines safely. Medicines were stored in an unlocked cupboard within the decontamination room, which was also unlocked. Following feedback, the service immediately moved the medicines into a locked cabinet for secure storage.

The practice did not have systems for appropriate and safe handling of medicines. The practice did not label dispensed medicine boxes with all requirements as stipulated by The Human Medicines Regulations 2012. While patient name, frequency and dosage were included, the practice did not include the name and address of the dental surgery, date and any associated precautions. The provider did not have an adequate stock control system for medicines which were held at the practice. While the practice told us that they reviewed all prescribed medicine with logs, audits and checks by the head nurse, we did not see any evidence of this on the day of our assessment, In addition, staff were unable to provide us with assurances that any missing prescription only medication could be identified and appropriate action taken. Antimicrobial prescribing audits were carried out, but these did not identify that antimicrobial prescribing was not always in line with current guidance from the Faculty of General Dental Practice and the Faculty of Dental Surgery of the Royal College of Surgeons of England.