Kimbolton 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 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 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 and checked in accordance with national guidance. Improvements were required to ensure that the medicines contained in the kit fully complied with Resuscitation Council UK guidance, for example the aspirin was in the tablet not dispersible form. Following the inspection, we saw that this had been purchased.

The premises were clean, well maintained and free from clutter. Hazardous substances were clearly labelled but not all were stored safely. For example, hazardous cleaning products were kept in an unlocked cupboard in the toilet which was accessible by patients.

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

The practice ensured equipment was safe to use and maintained and serviced according to manufacturers’ instructions. The last Electrical Installation Condition Report (EICR) was dated 2021 and had rated the system as unsatisfactory. It was unclear if the actions had been completed. Following the inspection, the practice told us a new EICR had been arranged.

A fire safety risk assessment had been carried out by a member of staff who was not able to demonstrate competency to do so. Whilst the fire alarms were being tested on a regular basis, they were not serviced, and staff were unaware if this was a requirement. Additionally, there was no justification or mediation for not having any emergency lighting. There was a domestic dwelling above the practice, and it had not been included as part of the fire risk assessment. Following the inspection, we saw that the practice had purchased one torch, and they told us a fire risk assessment had been arranged by a certified fire risk assessor.

The practice had arrangements to ensure the safety of the X-ray equipment and the required radiation protection information was available. Whilst we saw that staff had the required training, we found that the principal dentist last completed cone beam computed tomography (CBCT) training in 2016 and it was unclear if this included being able to both refer and interpret scans which were both being carried out. The principal dentist was unsure if any additional training had been completed since 2016, and no further certificates were seen.

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 a sharps risk assessment. Improvements were required to ensure the practice’s sharps procedures were compliant with the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013. Safer sharps were not used, for example needle-blocks to remove and hold the needle cap which allow safe one-handed recapping. Additionally, we were told that whilst dentists were dismantling used sharps, the nurses were disposing of the sharps into a sharps bin in the decontamination room. This meant staff were at increased risk of an inoculation injury. Following the inspection, we saw that the sharps bin had been moved into the surgery, and we were told that dentists will now be disposing of sharps at the point of use.

The risk from lone working had not been assessed. Following the inspection, we saw that a risk assessment had been completed.

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

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 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 to help them employ suitable staff, including for agency or locum staff. This reflected the relevant legislation. Improvements could be made to ensure that the policy was always being followed when recruiting staff, for example obtaining evidence of conduct in previous employment. We saw that the practice had not requested any references for 2 newly recruited staff members. Additionally, we saw that there was no evidence of immunity to Hepatitis B for any nurses, or an associated risk assessment in place. Following the inspection, we saw that a risk assessment for not having evidence of immunity to Hepatitis B had been completed and the practice was discussing how to arrange blood tests.

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.

The practice appeared clean and there was an effective schedule in place to ensure it was kept clean.

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 generally aligned with national guidance. Improvements were required to ensure adherence with Health Technical Memorandum 01-05: decontamination in primary care dental practices (HTM01-05). For example, heavy duty gloves were not being used for manual scrubbing of dirty instruments in the decontamination process, and the brush used did not have a long handle. The temperature of the water used for manual scrubbing of instruments was not monitored. Following our feedback, the practice told us that heavy duty gloves will now be used. We were also told that a thermometer had been purchased to monitor the water temperature.

The decontamination 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.

Staff had appropriate training, and the practice completed infection prevention and control (IPC) audits in line with current guidance. However, we saw that the audit was not reflective of processes in the practice, and hence was not suitable to drive improvement.

The practice had procedures to reduce the risk of Legionella, or other bacteria, developing in water systems, in line with a risk assessment.

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.