Whitefield Orthodontic Clinic

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.

The practice had processes to identify and manage risks and staff we spoke with were able to describe these to us. Staff demonstrated an open culture in relation to people’s safety. Staff felt confident that risks were well managed at the practice, and this was reflected in our findings.

The practice had carried out a Health and Safety risk assessment to help them manage risks to staff and patients however this did not reflect protocols at the practice. We discussed this with the principal orthodontist and were assured this would be rectified when the next risk assessment is carried out.

The practice had suitable procedures for the management of sharps and staff knew what to do in the case of a sharp’s injury. However, information displayed within sharps injury posters contained out-of-date information and there were no sharps bins in the surgeries. The provider took immediate action during the assessment day. They created a new poster and placed these in necessary areas, and new sharps bins were placed in the surgeries.

Most emergency equipment and most medicines were available, and staff could access these in a timely way. We noted that governance processes for checking the kit were not always working effectively. The checklist did not include expiry dates, which meant there was no prompt for staff to check these regularly. We found some equipment had expired, such as needles and syringes and self-inflating bags with reservoir. We also noted the aspirin was not the recommended form and glucagon (to treat low blood sugar) was stored at room temperature but there was no date adjustment. The provider took immediate action and ordered all missing items on the day of the assessment. They also developed and implemented a new weekly checklist on the day.

Staff knew how to respond to a medical emergency and had completed training in emergency resuscitation and basic life support every year.

The premises were visibly clean, well maintained and free from clutter.

Hazardous substances were clearly labelled and stored safely. However, the practice’s governance systems to minimise the risk that could be caused from substances that are hazardous to health (COSHH) should be improved. They had carried out risk assessments, but staff did not have access to safety data sheets. We discussed this with the provider, and we were assured this would be addressed and rectified within the next 4 weeks.

We saw satisfactory records of servicing and validation of equipment in line with manufacturer’s instructions.

The management of fire safety was effective, and fire exits were clear and well signposted.

The practice had systems for appropriate and safe handling of medicines.

The practice had a recruitment policy and procedures that reflected relevant legislation, to help them employ suitable staff, including agency or locum staff.

The practice ensured clinical staff were qualified, registered with the General Dental Council and had appropriate professional indemnity cover. Newly appointed staff had an appropriate role specific structured induction.

Staff we spoke with had the skills, knowledge and experience to carry out their roles. They told us that there were sufficient levels of staff on duty at all times. They demonstrated knowledge of safeguarding and were aware of how safeguarding information could be accessed. Staff knew how to escalate safeguarding concerns within the practice and externally.

The practice had arrangements to ensure staff training, including continuing professional development, was up-to-date and reviewed at the required intervals.

There were effective processes to support and develop staff with additional roles and responsibilities. Staff discussed their learning needs, general well-being and aims for future professional development during annual appraisals, 1-to-1 meetings, during clinical supervision, practice team meetings and ongoing informal discussions.

Staff stated they felt respected, supported and valued, and they were proud to work in the practice.

The practice had infection control procedures that reflected published guidance. However, we noted these were not always followed, as detergent used for manual cleaning was not measured and we found unpackaged instruments in a cupboard in a surgery. There was also no evidence of weekly protein residue tests, quarterly foil ablation tests or quarterly cleaning efficacy test for the ultrasonic bath. We discussed these issues with the provider, who carried out a new infection prevention and control audit on 5 March 2025. We were assured the practice would follow published guidance moving forward.

Staff received appropriate training and demonstrated knowledge and awareness of infection prevention and control processes.

We observed use of personal protective equipment and the decontamination of used dental instruments, which mostly aligned with national guidance. However, we saw staff were not always using a visor when manually cleaning the instruments. We saw, and staff confirmed that single-use items were not reprocessed.

The practice had a risk assessment to reduce the risk of Legionella. However, governance processes were not always working effectively. There were no records to demonstrate that water testing and dental unit water line management were carried out. The provider acted immediately and carried out hot and cold water testing on 5 March 2025 and temperatures were within the recommended limits. We were assured the relevant checks would be carried out and recorded moving forward. The practice had protocols to ensure effective cleaning and safe segregation and disposal of hazardous waste. The equipment in use was maintained and serviced as per manufacturers’ instructions. The practice completed infection prevention and control audits in line with current guidance.

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