Approach Dentistry

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. 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 after the inspection we received information to confirm that all clinical 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. 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 checked in accordance with national guidance. Staff could access these in a timely way. 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 sterilisation equipment in line with manufacturer’s instructions. Improvements could be made to ensure weekly tests on the vacuum steriliser were recorded. In response to our inspection feedback the provider told us that infection prevention and control, including a refresher on testing of autoclaves had been added to the next practice meeting agenda. Fire exits were clear and well signposted. On the day of inspection, the fire extinguisher servicing was out of date. The provider took immediate action and told us that this had now been booked for 26 July 2024.

The practice had some systems in place to ensure equipment was safe to use, maintained and serviced according to manufacturers’ instructions, and the facilities were maintained in accordance with regulations. Servicing records for the autoclave and compressor were made available for review. The practice was unable to provide evidence that electrical installation condition checks had been completed and they did not have effective systems in place to ensure that portable appliances were safe to use. The air conditioning system had not been serviced since 2016. In response to our inspection feedback the provider told us that these services had now been booked for August 2024. A fire safety risk assessment was carried out in January 2024. However, not all recommendations made in the fire risk assessment had been acted upon. For example, the practice did not have fire doors. In addition, there were no records to show that fire evacuation drills were being carried out. We noted that since the most recent fire risk assessment in January 2024, the practice had refurbishment work carried out. The fire risk assessment had not been reviewed to reflect these changes. The practice had arrangements to ensure the safety of the X-ray equipment and the required radiation protection information was available. Improvements could be made to ensure that all intraoral radiography units had a rectangular collimator in line with the recommendations of the most recent performance check reports. The practice had risk assessments to minimise the risk that could be caused from substances that are hazardous to health. The practice had implemented some systems to assess, monitor and manage risks to patient and staff safety. This included sharps safety, sepsis awareness and lone working. The practice had systems for appropriate and safe handling of medicines. Antimicrobial prescribing audits were carried out.

At the time of our assessment, the patients 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. Most of them told us that there were sufficient staffing levels. Staff generally felt respected, supported and valued. Staff told us that ‘I do feel respected in all ways’. However, some staff felt that ‘more support in certain areas would be appreciated’. Staff discussed their training needs during annual and ongoing informal discussions. They also discussed learning needs, general wellbeing and aims for future professional development. One staff member told us that the ‘dentist always gives feedback on areas to improve and appreciates good performance’. 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. In response to our inspection feedback the practice submitted evidence that all staff had completed safeguarding training at a level appropriate to their role.

On the day of inspection the practice did not have a recruitment policy. Recruitment documents, including full employment history, evidence of conduct in previous employment and some Disclosure and Barring Service (DBS) checks were not available for review. The provider sent us the missing documents in response to our inspection feedback. Improvements were needed to ensure that the required recruitment documentation was obtained at the point of employment in line with the relevant legislation and that these were stored adequately for effective monitoring. The practice ensured clinical staff were qualified, registered with the General Dental Council and had appropriate professional indemnity cover. Clinical staff completed continuing professional development required for their registration with the General Dental Council. Improvements were needed to ensure the practice had a structured induction programme to prepare staff for their new role. The practice did not have arrangements to ensure staff training was up-to-date and reviewed at the required intervals. On the day of inspection various training documents, including safeguarding, medical emergency, fire awareness, legionella and sepsis certificates were not available for review for a number of staff members. In addition, some staff members had no training certificates on file. Improvements were needed to the systems in place for staff training monitoring to ensure appropriate action was taken quickly where training requirements were not met. Following the inspection the provider submitted most of the missing training certificates. Further improvements were needed to ensure all members of staff completed training in autism and learning disability awareness. We saw the practice had effective processes to support and develop staff with additional roles and responsibilities.

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 broadly aligned with national guidance. We noted that staff did not use a thermometer to record the water temperature during manual cleaning to ensure the temperature of the water was 45 degrees Celsius or lower. Following the insepction we were told that one was available but not used on the day. Some instruments had cement residue on them. The provider took immediate action and these instruments were reprocessed the same day. In addition, the practice told us that they had added infection prevention and control update to their next practice meeting scheduled for August 2024.

The practice had infection control procedures which broadly reflected published guidance and the equipment in use was maintained and serviced. Staff had appropriate training, and the practice completed infection prevention and control (IPC) audits in line with current guidance. Improvements could be made to ensure the audit reflected arrangements within the practice to effectively drive continuous improvement. The practice did not have effective procedures to reduce the risk of Legionella, or other bacteria developing in water systems. A Legionella risk assessment dated September 2021 was made available for review. We were not assured that all recommendations made in this risk assessment had been acted upon. There were no records of the monthly hot and cold water temperature checks. In addition, since the last Legionella risk assessment, the practice had refurbishment work, including the installation of a designated decontamination room. A new risk assessment had not been completed to reflect these changes. Following the inspection the practice told us that they would arrange a new Legionella 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.