The Care Quality Commission
  • Doctor
  • Independent doctor

Archived: Sunnah Circumcision Clinic

Overall: Good read more about inspection ratings

45 Fieldgate Street, London, E1 1JU

Provided and run by:
Dr Mohammad Hossain Howlader

Important: This service is now registered at a different address - see new profile

All Inspections

05/03/2022

During an inspection looking at part of the service

We carried out an unannounced focused inspection of Sunnah Circumcision Service at Maryam Centre on 5 March 2022, as a result of concerns raised with the CQC about service users not being asked to provide identification.

This report covers our findings in relation to the specific concerns raised with us which we looked at during our inspection visit, and does not change the current ratings held by the service.

Sunnah Circumcision Service at Maryam Centre was last inspected on 9 December 2020 and was rated as good overall and for all key questions.

Sunnah Circumcision Service at Maryam Centre is an independent health service providing faith and non-faith based non-therapeutic male circumcision for all age groups.

Our key findings were:

  • The service had a process to check service user identification and verify parental responsibility, however this was not being consistently adhered to by staff.
  • Staff we spoke with understood the reasons for asking parents for identification.
  • We saw one example in records where nothing had been recorded to demonstrate that the parents’ identification had been checked.
  • During the inspection, one of the service users told us they had not been asked for identification.
  • Immediately after the inspection, the provider amended the service’s forms to make the recording of checks clearer, and to act as a prompt for the non-clinical staff members.

Although we did not find any breaches of Regulation, the areas where the provider should make improvements are:

  • Improve systems for checking and recording identification so they are embedded throughout the service.
  • Improve the oversight and audit arrangements for monitoring that staff are adhering to the process for checking and recording identification.

Dr Rosie Benneyworth BM BS BMedSci MRCGP
Chief Inspector of Primary Medical Services and Integrated Care

9 December 2020

During an inspection looking at part of the service

This service is rated as Good overall. Previous inspection 21/09/2019 – Requires improvement

Overall, Inadequate for safe and Requires improvement for Well led.

The key questions are rated as:

Are services safe? – Good

Are services effective? – Choose a rating

Are services caring? – Choose a rating

Are services responsive? – Choose a rating

Are services well-led? – Good

We carried out an announced comprehensive inspection at Sunnah Circumcision Service at Maryam Centre on 9 December 2020.

At the last unannounced inspection on 21 September 2019 we rated the service as Requires improvement overall, inadequate for safe and Requires improvement for Well led and issued the service with a warning notice. Previous reports on this service can be found on our website at: https://www.cqc.org.uk/Sunnah Circumcision Service at Maryam Centre.

At this inspection we followed up on breaches of regulations identified at a previous inspection on 21 September 2019.

On that inspection we found;

  • Staff were not recording identity checks in line with the provider’s own policy.
  • Infection control procedures failed to identify concerns picked up during our inspection, including the cleaning and storage or equipment and single use items.
  • There were gaps in adult safeguarding training.
  • Not documenting Identity checks for those with parental responsibility.
  • Significant events were not being identified, recorded and investigated.
  • There were no patient records or policies accessible to staff to refer to onsite.

At this focused inspection, we found the service had made improvements following our previous inspection. As a result of the changes to the ratings for these two questions, there has been a change in overall rating.

We have rated this service as good overall.

Background

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the service was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

The Sunnah Circumcision Service at Maryam Centre is located in the London borough of Tower Hamlets and provides private health services. The services offered were faith and non-faith based cultural circumcision services for all age groups, including adults. The patients seen at the practice are often seen for single treatments and as such the clinic does not keep a patient list.

The services doctor is the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Our key findings were;

At the 2019 inspection:

  • The service had not been logging significant events appropriately, although they were dealing with them. At this inspection they were logging them, dealing with them analysing them and sharing learnings.
  • We found some gaps in safeguarding and basic life support training. At this inspection we found that the provider had completed the required inspection soon after the 2019 inspection.
  • We found that the service did not have an adequate process in place to verify patients’ identities. At this inspection we found that they had introduced a new for which checked the patient’s identity and that they had parental responsibility.
  • We identified some infection control risks regarding storage of cleaning equipment and single use items. At this inspection we found that the cleaning materials were stored in a designated cleaning cupboard and single use items were stored in their own cupboard and rotated regularly.

Dr Rosie Benneyworth BM BS BMedSci MRCGP
Chief Inspector of Primary Medical Services and Integrated Care

21/09/2019

During an inspection looking at part of the service

We previously carried out an announced comprehensive inspection of Sunnah Circumcision Service at Maryam Centre on 13 April 2019. At the inspection, we rated the service as good overall, but as requires improvement for providing safe services because:

  • The service had not recorded two incidents as significant events, although both were handled appropriately.
  • We found some gaps in safeguarding and basic life support training.
  • The service did not have an adequate process in place to verify patients’ identities, including checking that adults attending with children had parental responsibility and documenting this.
  • We identified some infection control risks during the inspection.

The full report of the April 2019 comprehensive inspection can be found by selecting the ‘all reports’ link for Sunnah Circumcision Service at Maryam Centre on our website at www.cqc.org.uk.

We carried out an unannounced focused inspection of Sunnah Circumcision Service at Maryam Centre on 21 September 2019 in response to information of concern. During the inspection we looked at whether the service was safe and well-led.

At this focused inspection, we found the service had not made improvements following our previous inspection and we found new concerns in relation to the safety and leadership of the clinic. As a result of the changes to the ratings for these two questions, there has been a change in overall rating.

We have rated this service as requires improvement overall.

We rated the practice as inadequate for safe and requires improvement for well-led because:

  • There was little evidence of learning from events or action taken to improve safety.
  • There was a policy to log and act upon significant events, however at this inspection we found that incidents that should have been identified and recorded as significant events were dealt with as complaints. An updated policy sent to us following our inspection did not classify post-operative complications as a significant event.
  • Staff were not following the provider’s own identity checks policy correctly. There was a process in place to check the identity of those with parental responsibility and the identity of the patient, but staff did not record what form of identity had been checked nor did they record the check had actually been completed.
  • The service could not demonstrate how they were assuring themselves that they were doing everything to ensure patients and those giving consent fully understood the pre and post-operative advice and felt sufficiently supported, including the risks associated with procedure.

  • Whilst the service had addressed the specific infection control concerns identified at our previous inspection, new areas of concern were found at this inspection. Specifically, we found issues relating to the cleaning and storage of equipment. We also found out of date single use items dating back to 2016.
  • Not all staff who interacted with patients had completed training in adult safeguarding.

We also found the service had acted upon a suggested area of improvement from the previous inspection:

  • At the previous inspection we found that, although the service had handled complaints appropriately and had met with the patients involved to discuss the matter, they did not send a formal complaints outcome letter. At this inspection we found that the service was now sending formal complaint outcome letters.

The areas where the provider must make improvements are:

  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

  • Review that they are doing everything to ensure patients and those giving consent fully understand the pre and post-operative advice and feel sufficiently supported and are aware of the risks associated with the procedure as well as allowing enough time for the procedure itself.
  • Review which documentation is kept on site; ensuring that staff have access to polices and patient notes as is necessary.
  • The service should consider how long they retain medical records in line with British Medical Association (BMA) guidance.

Dr Rosie Benneyworth BM BS BMedSci MRCGPChief Inspector of Primary Medical Services and Integrated Care

13 April 2019

During a routine inspection

This service is rated as Good overall.

The key questions are rated as:

Are services safe? – Requires improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Good

We carried out an announced comprehensive inspection of Sunnah Circumcision Service at Maryam Centre on 13 April 2019 as part of our inspection programme.

We had previously carried out an announced comprehensive inspection of the service on 4 November 2017 and found that it was compliant with the relevant regulations.

Sunnah Circumcision Service at Maryam Centre is an independent health service located in the London borough of Tower Hamlets, providing non-therapeutic male circumcision.

Our key findings were:

  • The service had not recorded two incidents as significant events, although both were handled appropriately.
  • On the day of inspection, we found some gaps in safeguarding and basic life support training.
  • The service did not have an adequate process in place to verify patients’ identities, including checking that adults attending with children had parental responsibility and documenting this.
  • We identified some infection control risks during the inspection, although the provider took prompt action to address these.
  • The service was aware of and complied with the requirements of the duty of candour.
  • Care and treatment was delivered according to relevant and current evidence based guidance and standards.
  • The service reviewed and monitored the effectiveness of the treatment provided.
  • Patient feedback about the service was positive.
  • The service organised and delivered services to meet patients’ needs. Patients could access the service in a timely way.
  • There was a clear leadership structure and staff told us they were supported and felt able to raise concerns.

The areas where the provider must make improvements are:

  • Ensure care and treatment is provided in a safe way to patients.

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

  • Ensure formal complaints outcome letters are sent.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

4 November 2017

During a routine inspection

We carried out an announced comprehensive inspection on 4 November 2017 to ask the service the following key questions; Are services safe, effective, caring, responsive and well-led?

Our findings were:

Are services safe?

We found that this service was providing safe care in accordance with the relevant regulations.

Are services effective?

We found that this service was providing effective care in accordance with the relevant regulations.

Are services caring?

We found that this service was providing caring services in accordance with the relevant regulations.

Are services responsive?

We found that this service was providing responsive care in accordance with the relevant regulations.

Are services well-led?

We found that this service was providing well-led care in accordance with the relevant regulations.

Background

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the service was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

The Sunnah Circumcision Service at Maryam Centre is located in the London borough of Tower Hamlets and provides private health services. The services offered were faith and non-faith based cultural circumcision services for all age groups, including adults. The patients seen at the practice are often seen for single treatments and as such the clinic does not keep a patient list.

The services doctor is the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

As part of our inspection we also asked for CQC comment cards to be completed by patients prior to our inspection. We received 95 comment cards which were all positive about the standard of care received. Patients said they felt the provider of services at the offered an excellent service and staff were helpful, caring and treated them with dignity and respect.

Our key findings were:

  • There was an effective system in place for reporting and recording significant events.
  • Risks to patients were always assessed and managed, the service held emergency drugs and had conducted a risk assessment for the omission of emergency equipment.
  • The clinic had a number of policies and procedures to govern activity.
  • The clinic had an infection control policy and had carried out an audit but this was not service specific.
  • Electrical equipment had been portable appliance tested (PAT).
  • The doctor assessed patients’ needs and delivered care in line with current evidence based guidance.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • Information about services and how to complain was available and easy to understand.
  • The clinic had good facilities and was well equipped to treat patients and meet their needs.
  • The clinic proactively sought feedback from staff and patients, which it acted on.
  • The provider was aware of and complied with the requirements of the Duty of Candour.

We identified regulations that were not being met and the provider should:

  • Carry out a service specific infection control audit.