Progressive Dentistry

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 knew how to respond to a medical emergency and had completed training in emergency resuscitation and basic life support every 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 with the exception of oromucosal Midazolam, a medicine used to treat prolonged epileptic seizures. The medicine had been in short supply and ordered prior to inspection. Following the inspection, we were sent evidence that the order had been fulfilled and the medicine was available at the location. Emergency equipment and medicines were checked on a monthly basis. Improvements were required to ensure emergency equipment and medicines were checked weekly in accordance with national guidance. There was no bodily fluids spillage kit or first aid eye wash. Following the inspection, the provider addressed this shortfall. The premises were clean, well maintained and free from clutter. Hazardous substances were clearly labelled but we observed some substances were stored in unlocked cupboards in the patient toilet and corridor and could be inadvertently accessed by patients, including children. Following our feedback, the provider ensured all hazardous substances were safely stored. We saw satisfactory records of servicing of equipment in line with manufacturer’s instructions. Improvements were required to ensure each autoclave cycle was validated in line with Health Technical Memorandum 01-05: Decontamination in primary care dental practices (HTM01-05) published by the Department of Health. The autoclave data logger had broken and just 2 autoclave cycles were being validated per day. Following the inspection, we were sent evidence of the comprehensive autoclave validation records prior to the failure of the data logger. Fire exits were clear and well signposted, and fire safety equipment was serviced and 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. A fire safety risk assessment was carried out in line with the legal requirements. The management of fire safety was effective although there were no records to show that the emergency lighting was checked on a monthly basis. 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. On the day of inspection we did not see evidence that the practice had risk assessments to minimise the risk that could be caused from substances that are hazardous to health on the day of inspection and were told these were not available. Following the inspection feedback, we were sent good quality risk assessments. The practice had implemented some systems which required improvement to assess, monitor and manage risks to patient and staff safety. Improvements were required to ensure the sharps risk assessment accurately reflected the practice processes. The practice had some systems for appropriate and safe handling of medicines. Improvements were required to ensure the refrigerator which stored Glucagon, a medicine to treat low blood sugar, was temperature monitored to ensure its efficacy. Food was also stored within this fridge. Following inspection, the provider agreed to store the medicine at room temperature with the other emergency medicines and reduce the expiry date accordingly. Antimicrobial prescribing audits were carried out, but these had not identified that 7 day courses of antibiotics were dispensed or prescribed instead of 5 day courses to reduce the chances of developing antibiotic resistance, following guidance published by the College of General Dentistry.

At the time of our assessment, the patients 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, during clinical supervision and practice team meetings and ongoing informal discussions. They also discussed learning needs, general wellbeing and aims for future professional development. 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.

The practice had a recruitment policy and procedure to help them employ suitable staff, including for agency or locum staff. Minor improvements were required to ensure these were followed to reflect the relevant legislation. In particular, evidence of conduct in previous employment (references) was not available for all staff. Following our feedback, the provider obtained the missing references. 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. 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 although improvements were required. 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, but the use of personal protective equipment (PPE) needed improvement. We observed the dental nurse carrying out decontamination duties without donning a disposable apron or adequate eye protection prior to scrubbing contaminated instruments. Hazardous waste was disposed of safely. However, the clinical waste was stored in a cupboard that was accessible to patients. Following the inspection, the provider ensured clinical waste awaiting collection was stored in a locked cupboard.,. We observed the decontamination of used dental instruments, improvements were required to align procedures with national guidance. In particular, we observed that instruments were scrubbed without being submerged, increasing the risk of contaminated aerosol. Following our feedback, the provider addressed this with staff to ensure the decontamination of contaminated instruments was completed correctly.

The practice had infection control procedures which broadly reflected published guidance and the equipment in use was maintained and serviced. Staff had appropriate training, and the practice completed infection prevention and control (IPC) audits which required improvement. The audits were carried out annually instead of at 6-monthly intervals in line with current guidance and more care was required to ensure they were completed accurately to reflect the processes and identify where improvement was required. The practice had some procedures to reduce the risk of Legionella, or other bacteria, developing in water systems, in line with a risk assessment. We noted that the risk assessment was suitable for domestic premises only and had therefore not identified the need to monitor the temperature of water at sentinel outlets on a monthly basis. Following our feedback, a suitable risk assessment was carried out by a competent person. The practice had policies and procedures in place to ensure clinical waste was segregated appropriately in line with guidance.

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