Grange Dental Surgery

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

We found this practice was providing well led care in accordance with the relevant regulations and had taken into consideration appropriate guidance. The provider had made improvements in relation to the regulatory breach we found at our inspection on 17 April 2024.

Find out what we look at when we assess this area in our information about our new Single assessment framework.

The judgement for Shared direction and culture is based on the latest evidence we assessed for the Well-led key question.

The judgement for Capable, compassionate and inclusive leaders is based on the latest evidence we assessed for the Well-led key question.

The judgement for Freedom to speak up is based on the latest evidence we assessed for the Well-led key question.

The judgement for Workforce equality, diversity and inclusion is based on the latest evidence we assessed for the Well-led key question.

At the assessment on 29 October 2024 we found the practice had made the following improvements to comply with the regulations: Audits of disability access, radiographs and infection prevention and control were being carried out in accordance with current guidance and legislation. Practice policies and procedures were being reviewed and monitored. There was a system in place to monitor staff training and to ensure that staff undertook periodic training updates in accordance with relevant legislation and guidelines. Risks relating to fire had been suitably identified and mitigated. Risks relating to hazardous substances had been identified and mitigated, however improvements could still be made to ensure this included all hazardous substances in the practice. Following the inspection, the practice showed us that this was in the process of being carried out. Arrangements for ensuring good governance and leadership had been strengthened, but improvements could be made to ensure this is sustained and further improved, for example improving communication between leaders. The practice had also made further improvements: The practice’s infection control procedures and protocols had been improved taking into account the guidelines issued by the Department of Health in the Health Technical Memorandum. NHS prescription pads were held securely and there were adequate systems in place to track and monitor their use. Following an updated Legionella risk assessment, we were told that the high risk action of descaling outlets had been carried out, although it had not been documented. The practice had carried out an antimicrobial prescribing audit, although it had not been identified that some prescribing was not taking into account the guidance provided by the College of General Dentistry.

The judgement for Partnerships and communities is based on the latest evidence we assessed for the Well-led key question.

The judgement for Learning, improvement and innovation is based on the latest evidence we assessed for the Well-led key question.