Castle & Costa

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.

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 completed training in emergency resuscitation and basic life support every year, yet one staff member was unclear how to respond to a medical emergency which might involve the use of oxygen. Improvements could be made to ensure staff knowledge was regularly updated and medical emergency scenarios were discussed in practice meetings. 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. A full portable medical emergency kit was carried in the practice’s car, so it was available on all domiciliary visits if needed. This included emergency medicines, a defibrillator and oxygen which were in line with guidelines issued by the British National Formulary and the Resuscitation Council (UK). 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 provider ensured equipment was safe to use and maintained and serviced according to manufacturers’ instructions. The premises were maintained in accordance with regulations. A fire safety risk assessment had been carried out; however, we were not assured that this was completed by a person who had the qualifications to do so. Following the inspection, we were told that an external fire risk assessment had been arranged. We saw that regular checks of smoke alarms were being completed and documented and the fire extinguishers had been serviced annually. Fire exits were clear and well signposted. There was no X-ray equipment installed at the premises and any patients that required a radiographic assessment were referred to a different service. The provider had risk assessments to minimise the risk that could be caused from substances that are hazardous to health. These were kept on the premises, and if necessary, staff treating patients at a different location would telephone the office (which was always manned during working hours) to access the data sheet. The provider had implemented systems to assess, monitor and manage risks to patient and staff safety. This included sharps safety, sepsis awareness and lone working. The provider had systems for appropriate and safe handling of medicines. Antimicrobial prescribing audits were carried out. We checked the service’s vehicle documentation and found it had appropriate business insurance and an MOT certificate in place. It displayed the correct warning sticker to indicate that oxygen was carried on board. A TREM card (traffic emergency card) was available. This must be carried in the cab of any vehicle that is transporting dangerous goods by road. It contains instructions and information that the driver can refer to in the event of an incident involving the hazardous load.

At the time of our assessment, feedback we received noted that the dentist was always accompanied by a dental nurse at every visit to promote personal and patient safety. Patients 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 for the service. Staff discussed their training needs during informal discussions. 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.

We were unable to look at the recruitment process as the practice had not had a new member of staff for over 10 years, and the provider did not have a recruitment policy to help them employ suitable staff. Following the inspection, we saw that a recruitment policy had been implemented. We saw that 2 of the staff members were low/poor responders to the Hepatitis B vaccine yet there was no associated risk assessment in place. There were no records of Hepatitis B immunity for 2 other staff members. Following the inspection, we were told that records were being obtained and staff were going for blood tests to confirm their immunity. We were also told that a risk assessment for the low/poor responders was being put in place. The provider ensured clinical staff were qualified, registered with the General Dental Council and had appropriate professional indemnity cover. Clinical staff completed continuing professional development (CPD) required for their registration with the General Dental Council. However, the provider did not have oversight of this process. Improvements could be made to the monitoring of staff training to ensure appropriate action could be taken quickly if training requirements were not being met. Additionally, the owner had provided CPD for staff without being able to demonstrate their own training, for example in infection prevention and control. We discussed with the provider to ensure they followed the guidance for CPD providers issued by the professional regulator The practice did not have arrangements to ensure staff training was up-to-date or was reviewed at the required intervals.

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. Improvements could be made by completing an effective schedule to ensure it was kept clean. Following the inspection, we were told these had now been implemented and will be completed. 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.

We saw infection control procedures which generally reflected published guidance and the equipment in use was maintained and serviced. Improvements could be made to ensure that heavy duty gloves used in the decontamination process were changed on a weekly basis and that this was documented. Following the inspection, we were told that a log had been implemented. Infection prevention and control (IPC) audits were completed; however improvements could be made to ensure that the audit was a true reflection of the process being followed, and to ensure this audit was repeated in the timescale as laid out in the Department of Health publication ‘Health Technical Memorandum 01-05: Decontamination in primary care dental practices (HTM01-05)’. We saw that an IPC audit which was completed in December 2023 had identified some areas for improvement which had not been completed by the time of our inspection. There were procedures in place to reduce the risk of Legionella, or other bacteria, developing in water systems, in line with a risk assessment. Policies and procedures were 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.