The Elms 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 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, recruitment and training, support and development of staff, and the infection prevention and control standards being followed at the practice. This resulted in a breach of Regulations 17, 18 and 19 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 all except 2 members of staff 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 and told us that he would contact an external company to conduct a new fire risk assessment. Staff felt confident that risks were well managed at the practice, and the reporting of risks was encouraged.

Emergency equipment and medicines were available and staff could access these in a timely way, however they were not being checked at the appropriate intervals in accordance with national guidance. The premises were on the whole clean, well maintained and free from clutter, however we saw that improvement was needed in the cleaning of some areas, in particular window ledges and seals and clinical waste bin areas in the decontamination room. 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.

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. A fire safety risk assessment was not carried out in line with the legal requirements. The management of fire safety was ineffective. In particular, the fire risk assessment had been completed by a person who couldn’t demonstrate the skills, knowledge and competency to carry out this type of assessment and it does not provide any information on what action to take in the event of a fire. In addition, the risk assessment refers to a fire alarm, when the premises does not have a fire alarm, only smoke alarms. Fire drills were being carried out annually, but the practice’s Health and Safety policy stated that these should be done 6 monthly. The practice had arrangements to ensure the safety of the X-ray equipment and the required radiation protection information was available. However, we didn’t see evidence that the practice was registered with the Health and Safety Executive (HSE) for working with ionising radiation. Following the assessment, we received confirmation that the practice is now registered with HSE. The practice had risk assessments to minimise the risk that could be caused from substances that are hazardous to health, but these had not been updated since 13 May 2019 and we are not assured that they included all of the substances currently in use. 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 we did not see occupational health contact details and information on sepsis awareness was not displayed. The practice had systems for appropriate and safe handling of medicines. Antimicrobial prescribing audits were 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, but we identified that some improvements were required in regard to safeguarding adults and children, mental capacity, fire safety and interacting with people with a learning disability and autistic people. They told us that there were sufficient staffing levels. Staff stated they felt respected and supported, but not always valued. They were proud to work in the practice. Staff discussed their training needs during annual 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, however we did not see documented evidence of training in this subject to the appropriate levels for 6 members of staff.

The practice had a recruitment policy and procedure to help them employ suitable staff, including agency or locum staff. These reflected the relevant legislation but were not always being followed. We did not see satisfactory evidence of conduct in previous employment for any staff, evidence of immunity to Hepatitis B was not available for 6 staff, full employment history was not available for 7 staff and information about any physical or mental health conditions relevant to the person’s capability was not recorded. We did not see a Disclosure and Barring Service (DBS) certificate for 4 staff and 3 staff had only a basic DBS check and no associated risk assessments had been completed. There was no evidence of photographic ID for 7 staff. The practice ensured clinical staff were qualified and registered with the General Dental Council (GDC) , but appropriate professional indemnity cover was not seen at the assessment for 7 clinical staff. We received confirmation of indemnity cover for 5 clinical staff following the assessment. The practice did not have arrangements to ensure staff training was up-to-date and reviewed at the required intervals nor effective processes to support and develop staff with additional roles and responsibilities. We were told by the principal dentist that newly appointed staff had an induction but we did not see evidence of this. On the day of inspection, some clinical staff were unable to demonstrate that they had undertaken highly recommended and recommended continuing professional development relevant to their roles as suggested by the GDC In particular, 2 clinical staff had not completed infection prevention and control (IPC) training, 6 clinical staff had not completed safeguarding vulnerable adults and children training as per Intercollegiate guidance, 3 clinical staff had not completed training in legal and ethical issues, 6 staff had not completed sepsis awareness training and 4 staff had not completed complaints handling training.

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. Staff told us that single use items were not reprocessed.

The practice appeared clean but there was no schedule in place to ensure it was kept clean and there was inadequate cleaning equipment for floors. We noted the surface of the dental chair and the clinician’s chair in surgery 2 were not intact, and the silicone seal between the wall and work surface was also not intact. The sharps container in surgery 1 was not dated. Staff followed infection control principles, including the use of personal protective equipment (PPE). Hazardous waste was segregated and disposed of safely. 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. However, not all staff had appropriate training, and the practice’s completed Infection prevention and control (IPC) audits were not completed at 6 monthly intervals in line with current guidance. 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 judgement for Medicines optimisation is based on the latest evidence we assessed for the Safe key question.