Dale of Harley Street Limited

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. Whilst there are issues to be addressed, the impact of our concerns relates 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 had completed training in emergency resuscitation and basic life in the last 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 practice had systems for appropriate and safe handling of medicines. Improvements could be made to ensure the practice carried out antimicrobial prescribing audits. Following the on-site assessment, the practice told us this would be implemented. We saw satisfactory records of servicing and validation of the sterilising equipment and compressor in line with the relevant legislation. A fire risk assessment had last been carried out on 27 May 2024. On the day of assessment, we noted that the practice had not acted upon all recommendations within the risk assessment. These included, providing all fire doors with appropriate and correct signage and ensuring that all fire doors and exit routes are clearly indicated. In addition, the fire risk assessment recommended that documentation of emergency lighting testing and maintenance records should be kept. The provider told us that these services had been carried out and commissioned by the landlord of the building, however the practice could not demonstrate that they had obtained evidence of these. The practice did not have procedures in place to assist Disabled people to evacuate the premises. Following the on-site assessment the provider told us that they had now displayed the required fire door and fire exit signage, arranged the testing of the emergency lights and smoke detectors and purchased an evacuation chair to assist persons with disabilities. The practice had not had an Electrical Installation Condition Report (EICR), which is required every 5 years. In response to our on-site assessment feedback the provider told us that this had been booked for 14 January 2025.

On the day of the assessment the required radiation protection information was not available. We do not assess compliance with the Ionising Radiation regulations 2017 and the Ionising Radiation (Medical Exposure) regulations 2017 but we do request services to provide evidence that demonstrates their compliance to inform our findings. Following the on-site assessment the practice sent evidence of the required radiation protection information. Improvements were needed to ensure the provider had systems for periodic testing and servicing of the X-ray units in a timely manner and to ensure the relevant radiation protection information was readily available. The practice had not assessed and mitigated the risks associated with lone working or hazardous materials used by the practice. On the day of assessment, risk assessments for the hazardous materials used by the practice were not available for review. The practice did not have a sharps risk assessment, identifying the types of sharps used and the practice specific control measures.

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. One staff member said, ”[staff member] and [staff member] are always available to offer their support, and they have always treated me with respect. I feel that the door is always open if I need to discuss patient care or anything else should the need arise.” Staff discussed their training needs during ongoing informal discussions. They also discussed learning needs, general wellbeing and aims for future professional development. One staff member told us, “I do receive feedback about performance which helps me to reflect on the care I provide and hopefully improve on it.” 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.

The practice had a recruitment policy and procedure to help them employ suitable staff, including for agency or locum staff. These broadly reflected the relevant legislation. Improvements could be made to ensure Disclosure and Barring Service checks were obtained at the point of employment and the practice kept records of evidence of conduct in previous employment. One clinical staff member did not have a record of evidence of their response to the Hepatitis B vaccination they had received. There were no records to show that the provider had assessed the risks associated for non-responding or unvaccinated staff. Following the inspection the provider submitted evidence to show they had booked an appointment for the blood test. The practice did not have effective arrangements to ensure staff training was up-to-date and reviewed at the required intervals. We noted not all members of staff had completed training in autism and learning disability awareness, legionella, safeguarding, sepsis awareness, and the Mental Capacity Act 2005. Overall, we were not assured that systems in place to monitor staff training were effective. Following the on-site assessment the provider submitted evidence to show that staff had now completed the recommended training and told us that personal development plans would be updated accordingly. The practice ensured clinical staff were qualified, registered with the General Dental Council and had appropriate professional indemnity cover.

While the practice appeared clean, improvements could be made to ensure environmental cleaning logs were used to quality assure the effectiveness of cleaning. 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. Staff demonstrated knowledge and awareness of infection prevention and control processes and we saw single use items were not reprocessed. Most staff had appropriate training, and the practice completed infection prevention and control (IPC) audits in line with current guidance. We were shown the Legionella risk assessment dated 1 February 2024. We noted that not all recommendations made in the Legionella risk assessment had been acted upon within the suggested timeframes. These included systems to ensure scaling fittings are descaled and ensuring that the monitoring of control schemes is being carried out. In addition, we observed limescale deposits on taps. Following the on-site assessment the provider told us that they had now implement monthly checks of the hot and cold-water outlets.

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