Dental Arts - Harrogate Also known as Ace Denta Ltd

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. 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. We will be following up on our concerns to ensure they have been put right by the provider. 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 which resulted in a breach of Regulations 12 and 17, adequacy and availability of emergency equipment and medicines which resulted in a breach of Regulations 12 and 17, management of people's medicines and prescriptions which resulted in a breach of Regulation 12 and 17, safe and effective recruitment, ongoing staff training, and support and development of staff which resulted in a breach of Regulation 17.

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 had completed training in emergency resuscitation and basic life support every year However, we were not assured that staff knew which items should be in the medical emergency kit as stated by the Resuscitation Council UK guidance as they were not aware that items were missing and the weekly checklist they were completing stated “all drugs within expiry date” but did not list individual items.

Not all emergency medicines or equipment were available and checked in accordance with national guidance. There was no adrenaline, needles and syringes to administer adrenaline, child-sized automatic external defibrillator pads, scissors, razor and gloves to ensure effective defibrillation or Glucagon, a medicine used to treat low blood sugar. Staff were aware that several items of medical emergency equipment had passed their expiry date and these items had not been replaced. These included adult-sized automated external defibrillator pads, all sizes of airway (sizes 0, 1, 2, 3 and 4), child and adult facemasks, child and adult self-inflating bags with reservoirs, plastic tubing, portable suction kit and child dose of buccal Midazolam, a medicine used to treat prolonged seizures. In addition, there was no mercury spillage kit. On the day of the assessment, the provider took immediate action to order missing and expired emergency medicines and equipment, and to risk assess patients who were due to attend for treatment to minimise the risk, and postpone care where appropriate, until these issues were addressed. They confirmed since the on-site assessment that all medical emergency medicines and equipment have been replaced. The premises were clean, well maintained and free from clutter. Hazardous substances were clearly labelled and stored safely. However, the safety data sheets were not stored in a way that would enable quick access in an emergency. The practice did not ensure equipment was safe to use and maintained and serviced according to manufacturers’ instructions. We did not see satisfactory records of servicing and validation of equipment in line with manufacturer’s instructions. We saw no evidence of the following during the assessment: a Gas Safety certificate for the boiler; an Electrical Installation Condition Report; a Portable Appliance Testing record and an annual service certificate for the compressor.

The practice did not ensure the facilities were maintained in accordance with regulations. A fire risk assessment was not in place to ensure fire safety arrangements were appropriate for the premises. There were no processes for staff to test whether current smoke detectors were in working order. A garage housed the compressor and other combustible materials including a gas cylinder. There was no consideration for whether fire detection equipment was appropriate in the garage. However, fire drills were being carried out in line with legal requirements. The practice did not have arrangements to ensure the safety of the X-ray equipment and the required radiation protection information was not available. There was no evidence of registration with the Health and Safety Executive for the use of radiography. There was no critical examination document for the X-ray machine in the upstairs surgery. Three-yearly routine testing was not being done regularly. We noted both machines had been tested the day before our assessment, but before that were not tested since 2016. There were no local rules for the upstairs X-ray machine, and we identified a potential issue that put the operating staff at risk of radiation exposure. Substances hazardous to health were not identified and risk assessed in line with the Control of Substances Hazardous to Health Regulations 2002. Data sheets were not available for all substances used in the practice, and there was no system to enable someone to locate the information for a particular substance in an emergency . Additionally, the use of Alpron (a disinfectant used for decontamination of dental unit water lines) was not in line with manufacturer’s guidance. The practice had not implemented systems to assess, monitor and manage risks to patient and staff safety. For example, there was no sharps risk assessment in place and we were not assured appropriate arrangements were in place to obtain advice and follow up after sharps incidents.

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

We were not assured that staff had the skills, knowledge and experience to carry out their roles because the practice’s recruitment policy was not consistently followed and there were gaps in knowledge identified during our assessment findings. For example, staff responsible for ongoing monitoring of the water did not have appropriate training or knowledge to enable them to do this effectively. However, we were assured that there were sufficient staffing levels and staff stated they felt respected, supported and valued. They were proud to work in the practice. Staff said they discussed their training needs during ongoing informal discussions. 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 did not have an effective system to employ suitable staff, including agency and locum staff. The recruitment policy and procedure reflected relevant legislation. However, the policy and procedure were not followed. The practice did not have evidence to show that all clinical staff were qualified, registered with the General Dental Council and had appropriate professional indemnity cover. We saw no evidence of professional indemnity for 2 staff members. We saw no evidence of the effectiveness of Hepatitis B vaccinations for 3 staff members. We saw no evidence of a Disclosure and Barring Service (DBS) check for 3 staff members. The practice did not have arrangements to ensure staff training was up-to-date and reviewed at the required intervals. Newly appointed staff had a structured induction, and clinical staff completed continuing professional development required for their registration with the General Dental Council although we did not see certificates for all the required subjects including safeguarding and fire safety for all staff members.

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 and there was an effective schedule in place to ensure it was kept clean. 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 was maintained and serviced. Staff had appropriate infection prevention and control training. However, staff were not completing required infection prevention and control audits. The risk of Legionella was not managed and staff responsible for ongoing monitoring of water systems did not have the appropriate training or knowledge to do so effectively. Thermal control was not being maintained by taking monthly water temperatures from identified sentinel outlets, and lesser used water outlets. In particular, the tap in the disused laboratory was not being flushed to prevent water stagnating. 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.