Archived: Diamond Dental and Medical Clinic

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. 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 development of staff, infection prevention and control standards not being followed at the practice, the adequacy and availability of emergency equipment and medicines, and a lack of a learning culture at the practice. These resulted in breaches of Regulations 12 (Safe care and treatment) and 17 (Good governance) 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.

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 not completed training in emergency resuscitation and basic life support. The Registered Manager told us that they completed the Legionella hot and cold-water temperature logs. Entries on the log were not reflective of the arrangements within the practice, in that each entry included hot and cold water temperature checks, although Surgery 1 only had hot water and the decontamination room only had cold water. The Registered Manager told us that they completed the fire safety checks log for the practice. When asked, they told us that they did not know how to test the fire alarm system, although this task had been marked as completed on the log. We were not assured the processes the Registered Manager described were effective to identify and manage risks in relation to Legionella and fire safety.

Emergency equipment and medicines were not available and not checked in accordance with national guidance. The premises were visibly dirty, poorly maintained and cluttered. Hazardous substances, such as bleach were not stored safely. Surfaces in the clinical area were not impervious or easily cleanable and the flooring in the decontamination room was not sealed. This was not in line with the Department of Health publication ‘Health Technical Memorandum 01-05: Decontamination in primary care dental practices’ (HTM01-05). Fire exits were not clearly signposted. Firefighting equipment was not clearly indicated as they were hidden behind a poster. The provider could not demonstrate that the fire alarm system and the emergency lighting system were regularly serviced.

There was a lack of required servicing and validation records of equipment, including the autoclave and the compressor, in line with manufacturer’s instructions or the current national guidance. The portable appliance testing carried out on 17 February 2024 identified the fridge in the kitchen was not suitable for use. However, we noted that that fridge was still in use. The management of fire safety was ineffective. A fire risk assessment dated 23 February 2024 was -available for review. This was not completed by a person with the qualifications, skills, competence and experience to do so. There were no records to demonstrate that fire evacuation drills were being carried out. The practice did not have suitable arrangements to ensure the safety of the radiography equipment, and the required radiation protection information was not available. A Radiation Protection Advisor (RPA) had not been appointed. This is a legal requirement. The provider could not demonstrate that electro-mechanical testing was carried out annually or in line with the manufacturer`s guidance for the radiography units. The Registered Manager told us that one of the units had been out of use for 6 months as the equipment was faulty. We noted from the dental imaging software records that despite this fault, the practice continued to use it. The practice had risk assessments to minimise the risk that could be caused from substances that are hazardous to health. However, we noted that these risk assessments were not effective as hazardous substances were not stored safely. The practice had not implemented systems to assess, monitor and manage risks to patient and staff safety. The practice had not undertaken a health and safety, sharps or lone worker risk assessment. Prescription pads were not stored securely. The antimicrobial prescribing audit was not suitable to drive continuous improvement.

The Registered Manager told us that the practice employed two registered dental professionals, a dentist and a dental nurse. They worked together at the practice every second weekend. The Registered Manager told us that dental treatment was provided on other days. We were not assured that dental treatment was being provided by a person with the qualifications, competence, skills and experience to do so safely. Additionally, based on the information submitted by the provider, dental treatment had been provided to a significant number of patients in May 2024 by a person who was not a registered dental professional. Staff we spoke with did not have skills, knowledge and experience to carry out their roles. Staff lacked sufficient knowledge of relevant nationally recognised guidance, including the most recent guidelines around antimicrobial prescribing, supporting better oral health, National Institute for Health and Care Excellence (NICE) guidelines, periodontal classifications, gaining consent from patients who have limited capacity to consent and of Gillick competency, by which a child under the age of 16 years of age may give consent for themselves in certain circumstances. Staff told us that they did not think there were sufficient staffing levels. Staff stated they felt leaders in the practice were approachable and they felt supported. Staff did not discuss their training needs during annual appraisals. The Registered Manager told us that annual appraisals had not been undertaken since 2021. Staff we spoke with did not demonstrate sufficient knowledge of safeguarding. Staff did not know their responsibilities for safeguarding vulnerable adults and children.

The practice’s recruitment procedure did not reflect the relevant legislation. The provider could not demonstrate that they had carried out the necessary checks to ensure that the director of the company was of good character and they had the qualifications, competence, skills and experience for the relevant office or position. The Registered Manager told us that the director did not have a personnel file and there were no documents to demonstrate that any checks had been carried out. In addition, information about staff set out in Schedule 3 of the regulation had not been confirmed before employment. We were not assured that all members of staff had the relevant Disclosure and Barring Service check or satisfactory evidence of conduct in previous employment. The provider failed to ensure that clinical staff were qualified, registered with the General Dental Council (GDC) and had the appropriate professional indemnity cover. There were ineffective systems in place to ensure that required training was completed. Not all staff members had completed relevant training, including Legionella, sepsis, learning disability and autism awareness, Mental Capacity Act (2005), fire awareness or basic life support training.

On our visit of 24 May 2024 we saw staff completing autoclave validation logs and infection control checklists. When asked, they told us that they were signing off the log and checklists retrospectively for dates when they were not present at the practice. This meant that these validation logs and checks had not been completed contemporaneously to reflect actual checks. Staff did not demonstrate adequate knowledge and awareness of infection prevention and control processes. For example, staff were not aware of the requirement around the flushing and disinfection of Dental Unit Waterlines (DUWLs).

On 24 May 2024, the practice appeared visibly dirty and there was a lack of effective systems in place to ensure it was kept clean. Staff did not follow infection control principles in line with the current guidance. We observed dried blood on the dental cabinet handles in Surgery 1, tissues and clinical gloves discarded on the floor, cluttered work surfaces, cement residue on radiography unit switches and dirty handpieces left on the dental chair delivery unit after use. There were ineffective systems in place to ensure that single-use devices were only used during a single treatment episode and then disposed of. In Surgery 1, we found items intended for single use, including endodontic files which appeared to have been reused. In the decontamination room we observed single use aspirators, a single use 3-in-1 tip and single use intraoral scanner tips, which had been through the decontamination process and not disposed of after use. Hazardous waste was not segregated and disposed of safely. The decontamination of used dental instruments did not align with national guidance. There were no systems in place to monitor the storage time of unwrapped instruments, the water temperature was not monitored throughout the cleaning process and transportation boxes were not clearly identified. The autoclave was not tested and instruments were not sterilised in line with current guidance. We noted that although the practice had a full list of patients on 9 and 12 and 17 May 2024, there was no documented evidence that the autoclave was validated or used on those dates to sterilise instruments.

The practice infection control procedures did not reflect published guidance. Staff had not received appropriate training. The practice completed infection prevention and control (IPC) audits, however these did not reflect arrangements we saw within the practice and were not suitable to drive continuous improvement. The practice procedures to reduce the risk of Legionella, or other bacteria, developing in water systems were not effective. The practice could not demonstrate that the legionella risk assessment dated 7 September 2021 had been regularly reviewed by a person with the qualifications, skills, competence and experience to do so. Hot and cold water temperature checks were not reflective of the arrangements within the practice. There were no systems in place for the flushing and disinfection of DUWLs. The practice procedures in place to ensure clinical waste was segregated and stored appropriately was not in line with guidance. We saw clinical waste, including used gloves and masks in the general waste bin of the room used as an office. Clinical waste awaiting collection was not stored securely.

The judgement for Medicines optimisation is based on the latest evidence we assessed for the Safe key question.