Swakeleys 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. During our assessment of this key question, we found concerns related to the safety of the premises and equipment, safe and effective staffing, recruitment of staff, training, support and supervision of staff, the infection prevention and control standards not being followed at the practice, the adequacy and availability of emergency equipment and medicines, management of people's medicines and prescriptions and a lack of a learning culture at the practice. These concerns resulted in breaches of Regulations 12 (Safe care and treatment), 17 (Good governance), 18 (Staffing) and 19 (Fit and proper persons employed) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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.

We asked to see the practice fire risk assessment. We were provided with a generic document setting out the relevant legislation, arrangements a service should have in place as part of their fire safety measures and steps that should form part of a fire risk assessment. This document was not suitable to assess, identify and mitigate the risks associated with fire at the practice. We were later provided with another document. We noted that this had not been completed by a competent person. We were not assured that the provider was aware where relevant fire safety documents were kept. In addition, they were unable to provide details about how the suitability of the available fire detection system had been assessed to provide adequate control measures within the premises.

Emergency equipment and medicines were not available and not checked in accordance with national guidance. There were no records to demonstrate that the practice checked the medical emergency drugs and equipment at least weekly as set out in the relevant guidance. The practice did not have repeat doses of adrenaline for children or adults in line with the manufacturer`s guidance. Sizes 0 and 4 oropharyngeal airways, sizes 0,1,2,3 or 4 clear face masks for the self-inflating bag, child face mask with reservoir and tubing and portable suction were not available. Glucagon (the emergency medicine used to treat severe low blood sugar) was stored in the fridge, but the systems in place to monitor the fridge temperature were not effective. An electrical installation condition report had not been carried out. The air conditioning system had not been serviced since 2021. The fire exit routes were not clearly signposted. The practice had 1 battery operated smoke detector positioned on the second-floor landing ceiling and we were shown records that it was tested monthly. The provider could not demonstrate that consideration had been given to the dimensions and the use of the building to ensure the fire detection system installed was suitable for the premises. The practice did not have an emergency lighting system installed. The practice had a fire action plan. However, a fire evacuation plan, showing a clear passageway to all escape routes or the location of emergency doors was not available. 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 the sterilising equipment and compressor in line with the relevant legislation.

The fire risk assessment was not carried out by a person who had the qualifications, skills, competence and experience to do so. Overall, the management of fire safety was not effective. The practice did not have arrangements to ensure the safety of the X-ray equipment, and the required radiation protection information was not available. The 3-yearly performance check dated 1 July 2021 for the intraoral x-ray unit was out of date and there were no records of recent annual electro-mechanical servicing. There were no servicing records available for the orthopantomogram (OPG) machine. The principal dentist told us that the OPG machine has been out of use for months. We noted that the intraoral X-ray unit was located downstairs in a separate radiography room and was jointly used by 2 surgeries. This meant that patients seen in the upstairs surgery had to walk down the stairs to have an X-ray taken, including radiographs during an endodontic procedure. We were not assured that the practice had identified and assessed the health and safety, and infection control risks associated with this arrangement to ensure that any potential risks can be sufficiently mitigated. The practice sharps risk assessment was not reflective of the arrangements within the practice. It stated that ‘All staff immunised against hepatitis B and their responses to vaccine checked’. This statement was not substantiated by our findings. We were not assured that the sharps risk assessment was suitable to assess, identify and mitigate risks. 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 lone working.

Staff we spoke with did not have the skills, knowledge and experience to carry out their roles. We identified gaps in staff`s knowledge of infection prevention and control and management of sepsis. Whilst staff told us that they received informal feedback, there were no records to demonstrate that staff discussed their training needs and future professional development during annual appraisals or 1 to 1 meetings. This included a lack of performance reviews for trainee dental nurses. Staff we spoke with demonstrated some knowledge of safeguarding although not all staff members were aware where relevant safeguarding information was kept within the practice. Training records were not always available. We were told staff had provided these on the morning of inspection and the practice had not had time to file them. We were not assured that the practice had sufficient oversight of staff training.

The practice had a recruitment policy that reflected relevant legislation. However, this was not always followed. Proof of identity including photograph ID, enhanced Disclosure and Barring Service (DBS) certificate, evidence of conduct in previous employment and full employment history was not on file for one staff member who was also the director of the organisation. Systems and processes were not effective to ensure the necessary fit and proper person checks had been carried out. The provider could not demonstrate that DBS checks had been carried out at the point of employment as they had relied on checks carried out by other employers. These included DBS checks carried out in 2010, although the current owners took over the practice in 2019. There were no risk assessments to support the decision not to renew a DBS check. Satisfactory evidence of conduct in previous employment concerned with the provision of health and social care, and children and vulnerable adults had not always been obtained. We were not assured that the provider had robust systems in place to ensure trainee dental nurses were enrolled on a relevant course. The documents the provider submitted were out of date or did not confirm current enrolment. Not all clinical staff had a record of hepatitis B vaccinations or evidence of their response to the vaccination. There were no records to show that the provider had assessed the risks associated to non-responding or unvaccinated staff. There were no systems in place to ensure that all newly appointed staff had received a structured induction, including infection prevention and control and safeguarding training for trainee dental nurses. The practice did not have arrangements to ensure staff training was up-to-date and reviewed at the required intervals. Not all members of staff completed training in basic life support, autism and learning disability awareness, fire safety, legionella, sepsis awareness and infection prevention.

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. We observed the decontamination of used dental instruments, which did not align with national guidance. Staff did not use a detergent to disinfect instruments during scrubbing. Instruments were not fully immersed during the cleaning process to ensure aerosol risk was minimised. The temperature of water was not monitored throughout the cleaning process to ensure it was 45C or lower. There were no systems and processes to monitor the use of long-handled brushes and domestic gloves. Staff did not wash their hands before and after undertaking decontamination of used dental instruments. Staff did not use the dedicated bowl for rinsing instruments but used the same sink for rinsing as the one used for the original wash. After sterilisation, instruments were not wrapped immediately but left to airdry for hours. There were no systems and processes in place to ensure the separation of instrument reprocessing from other activities by physical or temporal means. The decontamination room opened directly from the staff room, which was also used as a kitchen. We observed that staff had not closed the sliding door separating the kitchen from the decontamination room during the decontamination process which took place before lunch break. We were not assured that staff had identified the risks arising from the preparation of food and drinks in the area adjoining the room used to process dental instruments contaminated with bodily fluids.

The practice had infection control procedures which did not reflect published guidance. We identified gaps in staff`s knowledge of infection prevention and control. The provider did not ensure that trainee staff had received the suitable level of training and support they needed in their journey of learning new skills. Not all members of staff had completed infection prevention training. The practice completed infection prevention and control (IPC) audits. However, these were ineffective as they had not identified the issues found during the inspection. The practice had procedures to reduce the risk of Legionella, or other bacteria, developing in water systems, in line with a risk assessment. Improvements could be made to ensure the practice took action when the temperature of the hot water outlets did not reach 50C, as per the practice policy and recommendation of the Legionella risk assessment. The practice had policies and procedures in place to ensure clinical waste was segregated and stored appropriately in line with guidance.

Staff were not aware of current prescribing guidelines ‘Antimicrobial Prescribing in Dentistry’ guidance published by the College of General Dentistry (CG Dent). Prescription only medication and prescription pads were not stored securely. We brought this to the provider`s attention and they took immediate action to ensure medicines were stored securely.

The provider did not have systems in place for the appropriate and safe handling of medicines. The stock control in place was not suitable to monitor the number of doses kept on site and to identify any missing medication. Antimicrobial prescribing audits were carried out. However, these were not detailed enough to drive improvement and were not aligned to the current guidance.