The Dental Team

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. The impact of our concerns in terms of the safety of clinical care, is minor for patients using the service. During our assessment of this key question, we found concerns related to the safety of the premises and the adequacy of risk management systems. This resulted in a breach of Regulations 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can find more details of our concerns in the assessment findings below. Whilst there are issues to be addressed, the impact of our concerns relate primarily 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 most staff had completed training in emergency resuscitation and basic life support every year. We discussed the importance of ensuring all staff understood their role in the event of an incident. Emergency equipment and medicines were available, with the exception of repeat doses of adrenaline. These were obtained on the day. We discussed the importance of ensuring prompt action was taken to ensure all emergency medicines were available in accordance with recognised guidance. Staff we spoke with told us that equipment and instruments were well maintained and readily available. The leadership team described the processes they had in place to identify and manage risks. From our findings on the day, these were not effective. A fire safety risk assessment was carried out in December 2017 in line with the legal requirements. The practice had a manually operated fire alarm and battery operated smoke detectors in some rooms. There was no form of emergency illumination available at the practice. From the records we were shown, we could not be assured all fire safety risks had been considered, for example in relation to the basement area and the residential premises above the practice. We were told a new fire risk assessment was planned to be carried out shortly after the assessment. The risks to all staff working alone had not been considered and mitigated. Formal arrangements were not in place to ensure patients could access care in the event of the practice closure.

Areas accessed by patients appeared visibly clean and uncluttered. We noted improvements were needed to ensure the environmental cleaning equipment was replaced when heavily soiled and to ensure it was stored appropriately. In addition, hazardous substances were not consistently stored safely. We saw these were stored in an unlocked cleaner’s cupboard, easily accessible to unauthorised persons. We saw satisfactory records of servicing and validation of equipment in line with manufacturer’s instructions, with the exception of the ultrasonic bath. The practice told us the unit was new, but records were not available to demonstrate this. Due to an issue in the existing rear fire exit door, the fire exit was relocated via an alternative route and the signage was adjusted. However, the new route did not allow for an unimpeded exit with furniture and staff belongings causing obstructions. Staff told us NHS prescription pads were kept secure, and a log was in place to monitor and track their use. However, this was not effective. From the records we were shown the practice could not account for all prescriptions. The practice should take action to ensure audits of antimicrobial prescribing are undertaken at regular intervals to improve the quality of the service. The practice should also ensure that, where appropriate, audits have documented learning points and the resulting improvements can be demonstrated. Staff described the protocols in place for the management of substances hazardous to health. We noted the practice did not have risk assessments to minimise the risks. Safety data sheets for some products were available. However, we could not be assured staff were aware how to access this information in the event of an incident.

The practice ensured most equipment was safe to use and maintained and serviced according to manufacturers’ instruction. We noted the annual gas safety certificate was last carried out in September 2023 and the portable appliance testing (PAT) testing was last carried out in November 2020. The group’s protocol stated this would be undertaken every 2 years. The practice had systems to ensure the building was maintained in accordance with regulations. However, we could not be assured these were effective. For example, there were areas of damp in the practice, broken and missing ceiling tiles and flooding visible in the basement area. The practice had arrangements to ensure the safety of the X-ray equipment. Improvements were needed to ensure all required radiation protection information was available relating to the employer’s responsibilities. Accurate plans of the rooms and their surroundings, including any areas above and below the X-ray room were not available in the radiation protection file. The plans we were shown did not detail room measurements, the control zone, or the room construction. Rectangular collimators were not in-use on all X-ray units. In addition, records were not available to demonstrate radiography audits had been carried out since March 2023. The practice did not have effective systems to assess, monitor and manage risks to patient and staff safety. The sharps safety risk assessment we were shown did not reflect the protocols at the practice and we could not be assured important information relating to the post-exposure protocols was available for staff in all clinical areas. We saw the lower section of the boiler casing in the staff room had been removed exposing wires and the risks of this had not been considered. A pump had been installed in the basement to remove the build-up of water in this area, but it did not completely prevent water pooling under some electrical equipment.

Staff we spoke with described ongoing challenges with staffing levels. There were a number of recently appointed team members. We could not be assured all staff had the skills, knowledge and experience to carry out their roles and additional ongoing support should be introduced. The leadership team were open and honest about the challenges and described the steps being taken to address the issues. 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. These reflected the relevant legislation. Improvements were needed to ensure these were followed. We looked at a number of staff files and from the records we were shown, we noted Disclosure and Barring Service (DBS) checks or appropriate risk assessments were not consistently carried out at the point of recruitment. Where records indicated the recommended level of immunity to Hepatitis B had not been achieved following the completion of vaccination courses, there was no evidence the risks of this had been considered. Satisfactory evidence of conduct in previous employment was also not available for all staff members. The practice ensured clinical staff were qualified, registered with the General Dental Council and had appropriate professional indemnity cover. The practice had ineffective arrangements to monitor staff training to ensure it was up-to-date and reviewed at the required intervals. Protocols were in place to request training certificates from staff and new-starters. However, if this was not provided, there was no evidence this was followed up. Training records were not available for all staff members on the day of the assessment. We were shown records to indicate staff received a structured induction programme. We could not be assured these records were accurate following conversations with the team on the day.

Areas of the practice accessible to patients appeared visibly clean and there was a cleaning schedule in place. Improvements to the level of cleanliness was needed in some areas. The practice had a locked clinical waste bin available, but it was not secured. On the day we noted an unsealed clinical waste bag was left in the unlocked cleaner’s cupboard.

Decontamination of used dental instruments was not always in accordance with recognised guidance. Containers used to transport instruments to and from the decontamination (decon) area were not stored appropriately and the risks to staff had not been considered and mitigated. We could not be assured the manual cleaning solution was used in accordance with the manufacturer’s guidance. No routine testing was carried out on the ultrasonic bath to ensure its efficacy. We could not be assured hand soap was used consistently. Extractor fans to enable the correct air flow in the decon room were not working and were visibly dirty. The washer-disinfector was plumbed in but no longer in use and no flushing arrangements were in place. No visors were available or in use in the decon room and we could not be assured the heavy-duty gloves were changed frequently in line with guidance.

The practice had infection control procedures which did not fully reflect published guidance. Improvements were needed to ensure staff adhered to guidance, including The Health Technical Memorandum 01-05: Decontamination in primary care dental practices, (HTM 01-05). The practice did not have any infection prevention and control (IPC) audits available for review on the day, however evidence was sent immediately after the assessment that this had been carried out in September 2024. We noted this was not being carried out every six-months as recommended. Improvements were needed to ensure these were completed at the recommended interval to drive the required improvements we observed on the day of the assessment. The practice had procedures to reduce the risk of Legionella, or other bacteria, developing in water systems, in line with a risk assessment from December 2017. From the records we were shown, we could not be assured all risks had been considered, for example in relation to the basement area, where dead legs were visible and no flushing protocols had been introduced. The practice carried out monthly water temperature monitoring as part of the Legionella management protocols. From the records we were shown, we noted the temperatures at some of the outlets were significantly higher than recommended and while it was noted caution signs were available at the outlets, no additional action had been taken to mitigate the risk.

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