Park Street Dental Practice

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 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. Staff felt confident that risks were well managed at the practice, and the reporting of risks was encouraged.

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. Emergency equipment and medicines were available and checked in accordance with national guidance. However, the required facemasks for the self-inflating bag were missing. We saw evidence that these were ordered on the day of assessment. Staff could access emergency equipment and medicines in a timely way.

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. 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, sepsis awareness and lone working. However, the sharps risk assessment did not accurately reflect procedures and processes within the practice. Since the assessment, we have received a new sharps risk assessment which has addressed these issues. A fire safety risk assessment was carried out in line with the legal requirements. The management of fire safety was effective. However, fire drills were not carried out. We raised this with staff and were assured they would be implemented. Emergency lighting was not tested monthly and logged. We raised this with staff and were assured this would be rectified. The practice had arrangements to ensure the safety of the X-ray equipment and the required radiation protection information was available. However, the X-ray machines had not had the required annual servicing. The day after our assessment, we received evidence that this had been booked in for 22 November 2024. The practice had systems for appropriate and safe handling of medicines. However, antimicrobial prescribing audits were not carried out. We raised this with staff and were assured they would be carried out annually going forward.

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 appraisals, practice team meetings and ongoing informal discussions. They also discussed learning needs, general wellbeing and aims for future professional development. 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. Staff told us they had received a structured induction programme, which included safeguarding.

The practice ensured clinical staff were qualified, registered with the General Dental Council and had appropriate professional indemnity cover. Newly appointed staff had a structured induction, and clinical staff completed continuing professional development required for their registration with the General Dental Council. The practice had a recruitment policy and procedure to help them employ suitable staff, including for agency or locum staff. These reflected the relevant legislation. However, Disclosure and Barring Service (DBS) checks were not always carried out prior to commencing employment at the practice. Following the assessment, the practice sent evidence that new DBS checks had been completed for staff that did not have recent ones at the point of recruitment. The practice had arrangements to ensure staff training was up-to-date and reviewed at the required intervals. However, fire safety training was out of date for 2 members of staff. We have seen evidence that this was completed on the day of the assessment. 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. Hazardous waste was segregated and disposed of safely. Staff followed infection control principles, including the use of personal protective equipment (PPE). However, rubber gloves used for manual cleaning were not changed weekly and logged as required. We raised this with staff and have seen evidence of of a log that was implemented immediately. We observed the decontamination of used dental instruments, which for the most part aligned with national guidance. However, cleaning solution made for the ultrasonic bath was being used to manually clean instruments. Additionally, we noted this ultrasonic cleaning solution was being used at an incorrect dilution. Validation logs for the ultrasonic cleaners were also inconsistent and not in-line with Health Technical Memorandum 01-05: decontamination in primary care dental practices. The practice should make improvements to their infection control procedures and protocols taking into account the guidelines issued by the Department of Health in the Health Technical Memorandum 01-05: Decontamination in primary care dental practices, and having regard to The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance’. We observed multiple out-of-date materials in surgeries, some over 5-years old. Staff confirmed that on the day of assessment all out-of-date stock was disposed of and new stock ordered.

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 practice had infection control procedures which reflected published guidance and the equipment in use was maintained and serviced. Staff demonstrated some knowledge and awareness of infection prevention and control processes. However, composite compules that are single use items were being re-used. A composite compule is a cartridge containing tooth-coloured resin used for fillings. We raised this with staff and were assured this would stop immediately and staff would receive training and support in this area. Staff had appropriate training, and the practice completed infection prevention and control (IPC) audits in line with current guidance. However, the IPC audit was ineffective as it did not reflect procedures and processes within the practice. We raised this with staff and were assured this would be rectified.

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