Centre Point 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 providing safe care in relation to safe and effective staffing in accordance with the relevant regulations, and had taken into consideration appropriate guidance. However, we found this practice was not providing safe care in accordance with the relevant regulations in relation to safe environments and infection prevention and control. We will be following up on our concerns to ensure they have been put right by the provider. The impact of our concerns, in terms of the safety of clinical care, is minor for patients using the service. 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, adequacy and availability of emergency equipment and medicines, and the mitigation of risks relating to Legionella, which resulted in a breach of Regulation 12 and 17 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 knew how to respond to a medical emergency and had completed training in emergency resuscitation and basic life support every year. Staff were encouraged to participate in medical emergency scenario training. 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 staff could access these in a timely manner. However, while weekly checks were completed in accordance with national guidance, this was not effective. The battery for the automated external defibrillator (AED) had expired in 2016, and the spare battery had expired in June 2023. Paediatric defibrillator pads had expired on 16 May 2024. There were no temperature checks to ensure that glucagon had been stored at a temperature between 2 and 8 degrees Celsius. The practice did not have dispersible aspirin tablets available to manage a potential medical emergency. Weekly checks had identified the absence of dispersible aspirin, but this had not been escalated. The practice took immediate measures before the inspection team left the premises, to ensure that alternative arrangements were in place so that medical emergencies could be dealt with effectively while the replacement equipment was awaited. This included having access to an AED from a neighbouring premises. The premises were clean, well maintained and free from clutter. Hazardous substances were clearly labelled, and most were stored safely. However, cleaning products were stored in the communal bathroom in a cupboard which could not be locked, which meant patients could access them. The practice took immediate action to address this concern. We found 10 items of dental materials which were out of date within the 2 dental surgeries. While we were assured these items were not in use, further improvements were required to ensure there is an effective system for identifying, disposing and replenishing out of date stock. We saw satisfactory records of servicing and validation of equipment in line with manufacturer’s instructions. Fire exits were clear and well signposted, and new fire extinguishers had recently been installed.

The practice had not ensured the facilities were maintained in accordance with regulations. There was no electrical installation condition report (EICR), which meant the provider could not be confident the electrical installations within the practice were safe and compliant with relevant legislation. An electrician had been booked to complete an EICR before the inspection team had left the premises. The management of fire safety was ineffective. A fire safety risk assessment was carried out in line with the legal requirements on 13 May 2024. This had identified 26 actions and stated that the current battery alarm system was inadequate. Previous fire risk assessments had been carried out internally and not by someone with the qualifications, skills, competence and experience to do so. The practice had taken immediate action to address the findings of the fire risk assessment. The practice had systems for appropriate and safe handling of medicines. However, the practice did not have systems in place to monitor the use of prescription pads to prevent fraudulent misuse. Following feedback, the practice took immediate action to ensure all prescriptions could be tracked. Antimicrobial prescribing audits were carried out. The practice ensured equipment was safe to use and maintained and serviced according to manufacturers’ instructions. The practice had arrangements to ensure the safety of the X-ray equipment and the required radiation protection information was available. The practice had risk assessments to minimise the risk that could be caused from substances that are hazardous to health. The practice had implemented systems to assess, monitor and manage risks to patient and staff safety. This included sharps safety and sepsis awareness. Further improvements could be made to assess the risks associated with lone working, as the cleaners worked out of hours.

At the time of our inspection, the patients we asked 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. They told us that there were sufficient staffing levels. Staff stated they felt respected, supported and valued. They were proud to work in the practice. Staff discussed their training needs during annual appraisals, practice team meetings and peer review meetings between the clinicians. They also discussed learning needs, general wellbeing and aims for future professional development. One staff member told us how they had been supported to develop into a managerial role after staring as a trainee dental nurse. 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. Staff told us they had received a structured induction programme, which included safeguarding.

The practice had a recruitment policy and procedure to help them employ suitable staff, including for agency or locum staff. These reflected the relevant legislation. The practice ensured clinical staff were qualified, registered with the General Dental Council and had appropriate professional indemnity cover. Newly appointed staff had a structured induction, and clinical staff completed continuing professional development required for their registration with the General Dental Council. The practice had arrangements to ensure staff training was up-to-date and reviewed at the required intervals. Further improvements were required to ensure all staff had completed training on learning disabilities and autism, at a level appropriate to their role. 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, which were broadly in line with published guidance. Staff told us that single use items were not reprocessed.

We observed the decontamination of used dental instruments, which broadly aligned with national guidance. While the water temperature was taken during manual cleaning of the dental instruments, further improvements were required to keep a log of the water temperature to ensure it is 45 degrees Celsius or lower. Dental instruments were wrapped and reprocessed after 28 days. Current guidelines state that wrapped instruments can be dated and stored for 1 year. We found unwrapped instruments, such as X-ray holders loose within cupboards in the clinical environment. Improvements were required to ensure all unwrapped instruments are reprocessed within 24 hours, according to guidelines issued by the Department of Health in the Health Technical Memorandum 01-05: Decontamination in primary care dental practices. The practice took immediate action following the inspection to ensure frequently used instruments were reprocessed daily, and less frequently used instruments were wrapped and dated, in line with this guidance. The practice appeared clean and there was an effective schedule in place to ensure it was kept clean. Further improvements could be made to ensure a cleaning log was used to monitor the efficiency of the environmental cleaning. Staff followed infection control principles, including the use of personal protective equipment (PPE). Hazardous waste was segregated and disposed of safely.

The practice had infection control procedures which reflected published guidance and the equipment in use. Staff had appropriate training, and the practice completed Infection prevention and control (IPC) audits in line with current guidance. The practice had some procedures to reduce the risk of Legionella, or other bacteria, developing in water systems, in line with a risk assessment. A Legionella risk assessment had been completed on 16 May 2024. The previous Legionella Risk Assessment had been completed in 2019. We saw that some of the recommendations from the 2019 risk assessment, such as keeping a log of water temperatures, had not been implemented. Improvements were required to implement the recommendations in the practice's Legionella risk assessment, taking into account the guidelines issued by the Department of Health in the Health Technical Memorandum 01-05: Decontamination in primary care dental practices, and having regard to The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance.’ 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.