Smilecare Dental Centre

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.

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.

At the time of the assessment not all staff knew how to identify adults and children at risk of significant harm. Staff did not know how to make a safeguarding referral or who to inform if they had concerns. Staff told us they would report any concerns they had to the principal dentist or practice manager. Following the assessment the provider told us they had reviewed, in detail the safeguarding processes and that all staff had completed necessary training and had their knowledge checked.

We did not receive any information of concern from partners.

At the time of the assessment the practice processes for safeguarding were ineffective and staff were unaware of their responsibilities for safeguarding vulnerable adults and children. The provider had some information available to staff in relation to safeguarding vulnerable adults and children. However, this was not kept updated. There was no evidence that the induction included familiarising staff with safeguarding arrangements. The safeguarding policy did not identify lead roles and local arrangements for safeguarding were dated 2012. The practice did not ensure that staff completed safeguarding training to the appropriate level or updated their training at appropriate intervals. Evidence of training was only seen for 1 member of staff. Following the assessment the practice overhauled their safeguarding processes, staff received necessary training and procedures were put in place to ensure that all staff were aware of local contacts and arrangements in the event of having to complete a referral. Policies were updated and lead roles were made clear.

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 had completed training in emergency resuscitation and basic life support every year. Immediate life support training (or basic life support training plus patient assessment, airway management techniques and automated external defibrillator training) was also completed by staff providing treatment to patients under sedation. 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.

Most emergency equipment and medicines were available and checked in accordance with national guidance. Staff could access these in a timely way. Following the assessment the medical emergency equipment was updated to include all recommended items. We observed that the risks associated with an absence of additional oxygen for treating patients under sedation at the same time as other patients had not been mitigated against. However, following the assessment the provider told us they would review the provision of sedation. 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 equipment in line with manufacturer’s instructions. The access to fire exits were clear but not signposted although this was done following the assessment. 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. At the time of the assessment a fire safety risk assessment had not been undertaken in accordance with the legal requirements; however, this was completed following the assessment. Improvements were also made to ensure that weekly fire alarm tests were documented, and the fire alarm was serviced 6 monthly. The practice had arrangements to ensure the safety of the X-ray equipment and the required radiation protection information was available. This included cone-beam computed tomography (CBCT), laser and handheld X-ray equipment. The practice had risk assessments to minimise the risk that could be caused from substances that are hazardous to health. The practice was required to improve their systems to assess, monitor and manage risks to patient and staff safety. Following the assessment the practice implemented a sharps risks assessment and processes, updated their lone working risk assessment and had a Legionella risk assessment carried out by a competent person. The practice had systems for appropriate and safe handling of medicines.

Patients who completed feedback on the day of the inspection responded positively that there were enough staff working at the practice and they were able to book appointments when needed.

Staff told us that there were sufficient staffing levels and they felt they had the skills, knowledge and experience to carry out their roles. Staff stated they felt respected, supported and valued. They were proud to work in the practice. Staff discussed their general wellbeing, but improvements were required to ensure that staff received regular appraisal.

Systems in place to oversee recruitment required timely improvement. The practice had a recruitment policy and procedure to help them employ suitable staff, including for agency or locum staff. However, these did not reflect the relevant legislation. There were no risk assessments in place for 4 staff where their Disclosure and Barring Service check (DBS) has been transferred from a former employer and no DBS in place for 1 staff. There was no evidence of Hepatitis B immunisation status for 2 staff and no assessments in place to mitigate the risks of not knowing staff immunisation status. Photographic identification was not available for all staff. There was no evidence of qualifications for 4 staff. There was no full employment history for 4 staff, and we did not see evidence of all staffs’ registration with the General Dental Council. Newly appointed staff did not have a structured induction, and there were no systems in place to monitor and track the training of staff. No training certificates were seen for 1 staff member. We did not see evidence that all required staff had completed appropriate training in radiography. No infection prevention and control training was seen for 3 staff and 8 staff had not completed fire safety training. No Legionella training was seen for 7 staff. No training in learning disabilities and autism was seen for 4 staff. No Mental Capacity Act training was seen for 6 staff. Following the assessment the provider reviewed their processes of recruitment and training and we were assured that staff would receive training appropriate to their duties and responsibilities.

Patients who completed feedback on the day of the inspection responded positively 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. We saw that not all staff had appropriate training, and the practice had not completed infection prevention and control (IPC) audits in line with current guidance. Following the assessment a schedule of audits was implemented and an infection control audit was underway. The practice had procedures to reduce the risk of Legionella, or other bacteria, developing in water systems, and following the inspection, a risk assessment was carried out in accordance with the legal requirements. 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.