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{{org_field_name}}

Registration Number: {{org_field_registration_no}}

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Oral Care Policy

1. Purpose

The purpose of this policy is to set out the arrangements by which {{org_field_name}} will promote, protect and maintain the oral health and dental well-being of individuals living at the service and ensure that they receive appropriate support with daily oral care and access to dental services.

This policy supports compliance with the Regulation and Inspection of Social Care (Wales) Act 2016, the Regulated Services (Service Providers and Responsible Individuals) (Wales) Regulations 2017, as amended, and the statutory guidance issued by the Welsh Ministers under section 29 of the Regulation and Inspection of Social Care (Wales) Act 2016.

In particular, {{org_field_name}} will ensure that individuals are supported to care for their teeth, dentures and mouth; that appropriate oral-health supplies are available; that oral health is monitored as part of daily care; that timely action is taken where concerns are identified; and that arrangements are in place for individuals to be placed under the care of a registered dental practitioner and to access dental and other healthcare services as required.

The service will provide oral care in a person-centred manner that respects each individual’s dignity, privacy, independence, wishes, preferences, communication needs, capacity and personal outcomes.

2. Scope

This policy applies to all employees of {{org_field_name}}, including nurses, healthcare assistants, care workers, and any other staff involved in assisting residents with their oral hygiene. It covers preventive care, daily oral hygiene routines, risk assessments, specialist interventions, record-keeping, and staff training to ensure the highest standard of oral health care is provided.

3. Related Policies

This policy should be read in conjunction with:

• CHW07 – Person-Centred Care Policy: Ensuring individualised oral care planning.
• CHW11 – Safe Care and Treatment Policy: Supporting safe oral hygiene practices.
• CHW18 – Risk Management and Assessment Policy: Identifying risks related to oral health issues.
• CHW17 – Infection Prevention and Control Policy: Preventing cross-contamination during oral care procedures.
• CHW27 – Staff Supervision, Training, and Development Policy: Ensuring staff competency in oral care delivery.

4. Policy Statement

{{org_field_name}} is committed to ensuring that all residents receive comprehensive oral care as part of their overall health and well-being. We recognise the importance of maintaining good oral hygiene to prevent infections, discomfort, and complications such as pneumonia or malnutrition. This policy promotes a proactive approach to oral health, integrating it into daily care routines, assessments, and multidisciplinary support when necessary.

5. Oral Care Assessment and Personalised Care Plans

Oral-health needs will form part of the assessment and personal-planning arrangements for every individual living at {{org_field_name}}.

An initial personal plan will be prepared in accordance with the requirements of the Regulated Services (Service Providers and Responsible Individuals) (Wales) Regulations 2017. Where the service commences urgently and there has not been sufficient time to prepare a personal plan beforehand, the initial personal plan will be prepared within 24 hours of commencement of the service.

As part of the provider assessment completed within seven days of commencement of care and support, the individual’s oral-health and mouth-care needs will be assessed. The assessment will take account of relevant existing care and support plans, health assessments, the individual’s views, wishes and feelings, identified risks and information provided by relevant representatives and healthcare professionals, where appropriate.

The oral-health assessment will consider, as applicable:

• the individual’s natural teeth, gums, tongue, lips and other oral tissues;
• dentures, partial dentures, bridges, implants or other dental appliances;
• known dental conditions and previous dental treatment;
• current dentist or dental service and relevant dental history;
• the individual’s usual oral-care routine and preferences;
• the individual’s ability to brush their own teeth and otherwise manage their oral care independently;
• the nature and level of support required from staff;
• oral or dental pain, sensitivity, swelling, ulceration, bleeding, infection, decay or other abnormalities;
• difficulties with chewing, eating, drinking or swallowing;
• dry mouth or excessive saliva;
• the effect of medication, illness or treatment on oral health;
• nutritional and hydration concerns associated with oral health;
• communication, sensory, cognitive or physical needs that may affect oral care;
• any known risks associated with oral care;
• the individual’s wishes and preferences concerning dental treatment; and
• whether further assessment or advice from a registered dental practitioner or another healthcare professional is required.

The outcome of the assessment will be recorded and incorporated into the individual’s personal plan. The personal plan will contain sufficient detail to tell staff what oral care is required, how and when it is to be provided, the individual’s preferences, what the individual can do independently, what support staff must provide, any relevant risks and the action to be taken if concerns arise.

The personal plan will be reviewed whenever the individual’s needs change and at least every three months in accordance with the statutory requirements for review of personal plans. Where there is a significant change in oral health, dental treatment, ability to undertake self-care or the support required, the relevant assessment and personal plan will be reviewed and revised without waiting for the next scheduled review.

The individual will be involved in the assessment, planning and review of their oral care. The placing authority and representative will also be involved where applicable and appropriate in accordance with the Regulations.

6. Daily Oral Care Routine

Individuals will be encouraged and enabled to maintain their own oral hygiene and independence wherever possible. Where support is required, staff will provide this in accordance with the individual’s assessment, personal plan, wishes and preferences.

Daily oral care will include, as appropriate:

• supporting or assisting the individual to brush their natural teeth regularly, normally at least twice each day, using an appropriate fluoride toothpaste unless a registered dental practitioner or other appropriate healthcare professional has advised otherwise;
• supporting the individual to clean dentures and other removable dental appliances in accordance with appropriate professional advice and manufacturers’ instructions;
• supporting removal of dentures at night where this is appropriate for the individual and consistent with dental advice and the individual’s preferences;
• ensuring dentures and personal oral-care equipment are identifiable to the individual and are stored hygienically and safely;
• supporting appropriate hydration where this forms part of the individual’s assessed needs;
• providing or supporting the use of prescribed or recommended oral-care products in accordance with professional advice; and
• supporting individuals with dry mouth in accordance with their assessed needs and any advice received from a registered dental practitioner, pharmacist, GP or other appropriate healthcare professional.

Oral health will be monitored as part of daily care. Staff providing or supporting mouth care will remain alert to changes including pain, bleeding, swelling, ulceration, broken or loose teeth, damaged or poorly fitting dentures, signs of infection, persistent changes in the mouth, difficulty chewing or swallowing, deterioration in food or fluid intake, or any other change from the individual’s normal oral condition.

Where a concern is identified, staff will take appropriate remedial action without unnecessary delay in accordance with Section 7 of this policy and the individual’s personal plan.

{{org_field_name}} will ensure that appropriate oral-health supplies required to meet individuals’ assessed needs are readily available and maintained in good condition.

Oral care will always be provided in a manner that protects the individual’s privacy and dignity and takes account of their communication needs, capacity, consent, wishes and preferences.

7. Managing Oral Health Issues

Any new, worsening or unexplained oral-health concern will be taken seriously and responded to promptly.

Staff must report concerns in accordance with the individual’s personal plan and the service’s escalation arrangements. Where the individual requires assessment or treatment by a dental or other healthcare professional, appropriate advice or assistance will be sought without unnecessary delay.

The following actions will apply:

• Pain or discomfort: New or worsening dental or oral pain must be recorded, assessed within the staff member’s competence and escalated appropriately. Dental or medical advice will be sought where required.
• Swelling, suspected infection or abscess: Facial or oral swelling, pus, suspected dental infection or other signs of infection must be escalated promptly and urgent dental or medical advice obtained where indicated.
• Bleeding, ulcers or unexplained oral lesions: Persistent, recurrent or otherwise concerning bleeding, ulceration, lumps, lesions or unexplained changes in the mouth must be referred for appropriate professional assessment.
• Broken, loose or decayed teeth: Dental advice will be obtained when broken, loose or visibly decayed teeth are identified or where these cause pain or interfere with eating or oral care.
• Dentures and dental appliances: Poorly fitting, damaged, lost or persistently uncomfortable dentures or other dental appliances will be reported and appropriate dental advice sought.
• Eating, drinking or swallowing difficulties: Where oral or dental problems affect eating or drinking, the individual’s nutritional and hydration needs will be assessed and monitored and relevant professional advice sought. Where swallowing difficulties are present or suspected, referral to the appropriate healthcare professional, including speech and language therapy where indicated, will be made through the appropriate clinical pathway.
• Significant deterioration: Sudden or significant deterioration, trauma, uncontrolled bleeding, severe swelling, breathing difficulty or any other condition that may constitute a medical emergency will be dealt with through the appropriate urgent or emergency healthcare pathway.

Staff must not diagnose dental disease unless they are appropriately qualified and professionally authorised to do so.

All identified concerns, advice sought, referrals, appointments, treatment, outcomes and actions required must be documented in the individual’s records. Where the individual’s oral-health needs or required support have changed, the relevant assessment and personal plan will be reviewed and revised.

8. Dental Appointments and Specialist Referrals

{{org_field_name}} will have arrangements in place to ensure that individuals living at the care home are placed under the care of a registered dental practitioner in accordance with Regulation 33 of the Regulated Services (Service Providers and Responsible Individuals) (Wales) Regulations 2017, as amended.

Where an individual is already under the care of a registered dental practitioner, {{org_field_name}} will, with the individual’s agreement and in accordance with applicable information-governance requirements, record the relevant details and support continuity of dental care.

Where an individual does not have access to a registered dental practitioner, the service will take appropriate steps to support access to NHS or other appropriate dental services. This may include general dental services, community dental services, special-care dentistry or other suitable local dental provision according to the individual’s needs and local arrangements.

Individuals will be supported to:

• access routine dental assessment and treatment where required;
• obtain dental advice where pain, decay, infection, oral deterioration or another dental concern is identified;
• access urgent or emergency dental services where required;
• attend dental appointments;
• communicate effectively with dental professionals; and
• understand advice, treatment options and follow-up arrangements in a manner appropriate to their communication needs and level of understanding.

Where an individual is unable to travel to a dental practice because of their assessed needs, the service will explore appropriate alternative arrangements, including domiciliary or community dental provision where such provision is available and clinically appropriate.

Staff arranging dental services must provide relevant information necessary for safe care, subject to the individual’s consent or other lawful basis for sharing information.

The outcome of dental consultations, treatment provided, recommendations, prescribed or recommended oral-care arrangements and follow-up requirements will be recorded and incorporated into the individual’s personal plan where relevant.

Responsibility for arranging and supporting access to appointments will be clearly allocated. Failure or difficulty in obtaining necessary dental services will be escalated to the Registered Manager so that alternative appropriate arrangements can be considered.

9. Infection Prevention and Control in Oral Care

All oral care must be provided in accordance with {{org_field_name}}’s Infection Prevention and Control Policy and current applicable infection-prevention requirements and guidance.

Staff must apply standard infection-prevention precautions appropriate to the activity being undertaken.

This includes:

• performing effective hand hygiene before and after providing oral care and after removal of gloves;
• using appropriate personal protective equipment according to the nature of the care being provided and the assessed risk of exposure to blood, saliva or other body fluids;
• ensuring personal oral-care equipment is used only for the individual for whom it is intended;
• storing toothbrushes, dentures, denture containers and other personal oral-care equipment in a clean and hygienic manner that minimises the risk of contamination;
• ensuring oral-care equipment is appropriately labelled or otherwise identifiable where necessary to prevent inadvertent sharing;
• cleaning and, where applicable, decontaminating reusable equipment after use in accordance with current infection-prevention guidance and the manufacturer’s instructions;
• using single-use items only once and disposing of them safely after use;
• safely managing waste generated during oral care; and
• ensuring staff do not share oral-care products or equipment between individuals where this could create a risk of cross-contamination.

Where equipment is damaged, contaminated in a manner that cannot be safely rectified, or no longer suitable for use, it must be replaced.

Staff must report infection-prevention concerns to the appropriate senior member of staff and take immediate action where required to minimise the risk of infection to individuals, staff and others.

10. Training and Staff Competency

To ensure high standards of oral care, all care staff at {{org_field_name}} receive training on:

• Oral health assessment and care planning.
• Safe and effective toothbrushing techniques for dependent residents.
• Recognising oral health concerns and signs of infection.
• Denture care and maintenance.
• Infection prevention and control in oral care delivery.
• Communication techniques for residents with dementia or sensory impairments.

11. Documentation and Record-Keeping

Accurate, contemporaneous and sufficiently detailed records will be maintained in relation to each individual’s oral health and dental care.

Records will include, where applicable:

• relevant oral-health assessments and reassessments;
• the oral-health requirements contained within the individual’s personal plan;
• reviews and revisions of the personal plan;
• daily oral care provided or supported, including specific care interventions where required;
• significant observations and changes in the individual’s oral health;
• oral or dental pain, swelling, infection, bleeding, ulcers, dental damage, denture problems or other concerns identified;
• action taken in response to identified concerns;
• dental and other relevant healthcare referrals;
• dental appointments and professional consultations;
• treatment, advice and recommendations received from dental or other healthcare professionals;
• follow-up actions and whether they have been completed;
• changes to oral-care products or techniques recommended by a healthcare professional; and
• any impact of oral-health problems on nutrition, hydration, swallowing, communication or general well-being where relevant.

Where information received from a registered dental practitioner or another healthcare professional results in a change to the individual’s required care and support, the individual’s assessment and personal plan will be reviewed and revised accordingly.

Records must be accurate, legible, up to date and completed as soon as practicable after the care, observation, consultation or action to which they relate.

All records will be stored securely and managed in accordance with the service’s records-management arrangements, applicable data-protection requirements and Regulation 59 of the Regulated Services (Service Providers and Responsible Individuals) (Wales) Regulations 2017, as amended.

Records relating to oral care and dental treatment will be made available to Care Inspectorate Wales where lawfully requested as part of its regulatory functions.

12. Monitoring and Compliance

{{org_field_name}} will maintain effective arrangements to monitor, review and improve the quality and safety of oral care provided by the service.

Monitoring will include appropriate review of:

• whether oral-health assessments have been completed as required;
• whether oral-health needs and required support are reflected accurately in personal plans;
• whether relevant personal plans have been reviewed at least every three months and sooner where needs have changed;
• whether daily oral-care interventions are being provided and recorded in accordance with the individual’s personal plan;
• whether appropriate oral-care supplies are readily available and maintained in good condition;
• whether oral-health concerns are identified, recorded and escalated appropriately;
• whether residents are placed under the care of a registered dental practitioner and supported to access dental services;
• whether dental recommendations and follow-up actions have been implemented;
• infection-prevention practice associated with oral care;
• relevant staff training, knowledge and competence; and
• patterns, omissions, delays, incidents, complaints or other concerns that may indicate a need for improvement.

The views of individuals will be sought regarding the oral care and support they receive. Where appropriate and consistent with the individual’s wishes and well-being, relevant representatives may also be invited to provide feedback.

Relevant findings from audits, feedback, incidents, complaints, professional advice and other monitoring activity will be reviewed and analysed. Where shortcomings or risks are identified, proportionate remedial action will be taken without unnecessary delay.

Actions arising from monitoring will be recorded and followed through to completion. Learning and improvements will be communicated to relevant staff.

Information obtained through oral-care monitoring and audit will, where relevant, contribute to the service’s wider arrangements for monitoring, reviewing and improving the quality of care and support.

13. Responsibilities

Service Provider

The service provider is responsible for ensuring that the service has appropriate policies, procedures, staffing, resources and governance arrangements to meet applicable statutory requirements and that care and support is provided in accordance with those arrangements.

Responsible Individual

The Responsible Individual will maintain appropriate oversight of the service’s arrangements for oral care as part of their wider statutory responsibilities for effective oversight, compliance and quality of care.

The Responsible Individual will ensure that suitable arrangements are in place to:

• monitor the quality and safety of care and support;
• ensure required records are maintained accurately and completely;
• ensure policies and procedures are reviewed and kept up to date; and
• identify and act upon areas requiring improvement.

Registered Manager

The Registered Manager is responsible for the day-to-day implementation of this policy and for ensuring that:

• individuals’ oral-health needs are assessed and incorporated into their personal plans;
• staff follow individuals’ personal plans and this policy;
• residents are supported to access appropriate dental services;
• appropriate oral-care supplies are available;
• staff receive appropriate training, supervision and support;
• concerns are escalated and acted upon appropriately;
• oral-health records are properly maintained; and
• oral-care practice is appropriately monitored and audited.

Registered Nurses, where employed by the service

Registered nurses will work within their professional scope of practice and will support the assessment, monitoring and escalation of oral-health concerns where this falls within their role. They will seek appropriate dental or medical advice where required and ensure relevant changes are reflected in the individual’s care arrangements.

Care Staff

Care staff are responsible for:

• providing or supporting oral care in accordance with each individual’s personal plan;
• promoting independence wherever possible;
• respecting each individual’s dignity, wishes and preferences;
• observing the individual’s mouth and oral condition while providing care;
• recognising and promptly reporting changes or concerns;
• accurately recording care provided and relevant observations;
• following infection-prevention procedures; and
• working within the limits of their training and competence.

Individuals and Representatives

Individuals will be encouraged and supported to participate in decisions about their oral care and dental treatment. Representatives will be involved where appropriate, with the individual’s agreement or other lawful authority and in accordance with the individual’s well-being.

14. Compliance with Welsh Regulatory Requirements

This policy supports compliance with the Regulation and Inspection of Social Care (Wales) Act 2016 and the Regulated Services (Service Providers and Responsible Individuals) (Wales) Regulations 2017, as amended.

In particular, {{org_field_name}} will ensure that:

• policies and procedures relevant to the service are appropriate, implemented and kept up to date;
• each individual’s care and support, including oral care, is provided in accordance with their assessed needs and personal plan;
• oral healthcare is monitored as part of daily care and appropriate action is taken when concerns are identified;
• appropriate oral-health supplies are readily available and maintained in good condition;
• individuals are placed under the care of a registered dental practitioner and are supported to access dental and other healthcare services as required;
• staff providing care and support are appropriately trained, skilled and competent for the work they undertake;
• appropriate infection-prevention and hygiene arrangements are followed;
• required records of assessments, personal plans, care interventions and healthcare involvement are maintained accurately, securely and kept up to date; and
• systems are in place to monitor, review and improve the quality of oral care provided.

Care Inspectorate Wales may consider compliance with these requirements when assessing the quality and safety of the regulated service.

15. Policy Review

This policy will be formally reviewed at least annually.

It will also be reviewed and, where necessary, amended before the scheduled annual review where:

• relevant legislation or regulations change;
• Welsh Government statutory guidance or applicable national guidance changes;
• Care Inspectorate Wales issues relevant regulatory guidance or identifies required improvements;
• the service’s Statement of Purpose or arrangements for delivering care and support change;
• audit, inspection, incident, complaint or safeguarding findings identify a need for amendment;
• professional guidance or evidence identifies a material change required for safe practice; or
• monitoring shows that the policy is not operating effectively.

The Responsible Individual will ensure that suitable arrangements are in place for the policy to be kept up to date. The Registered Manager will ensure that relevant amendments are communicated to staff and incorporated into practice.

Staff will have access to the current version of this policy and will be expected to understand and follow those parts relevant to their role.

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Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}
Reviewed on: {{last_update_date}}
Next Review Date: {{next_review_date}}
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