Transcend Consulting Rooms

Updated 18 November 2020

Transcend Consulting Rooms provides circumcision services from premises in London, and it has been registered with CQC since June 2019. The service provides circumcisions on a fee-paying basis.

The service is based on the ground floor of a building converted from residential premises at 65 Warren Drive North, Surbiton, London, KT5 9LG. It is located in the Royal Borough of Kingston-Upon-Thames and provides solely private health services. The services offered were faith and non-faith based cultural circumcision services for all age groups. Services are offered predominantly to children under the age of five. The patients seen at the practice are often seen for single treatments. The service is currently open on alternate Saturdays. The service is currently registered with the CQC to provide surgical procedures only.

The service’s 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. The service currently had no employees other than the registered manager, with reception services subcontracted through a location owned by the same provider in Cardiff, and a self-employed clinician assists with procedures on a contractual basis.

During the inspection we utilised a number of methods to support our judgement of the services provided. For example, we interviewed staff, and reviewed documents relating to the service.

To get to the heart of patients’ experiences of care and treatment, we always ask the following five questions:

• Is it safe?
• Is it effective?
• Is it caring?
• Is it responsive to people’s needs?
• Is it well-led?

These questions therefore formed the framework for the areas we looked at during the inspection.

Updated 18 November 2020

This service is rated as Good overall. We had previously carried out an announced comprehensive inspection of Transcend Consulting Rooms on 28 August 2019. At that time the service was rated as inadequate overall, and in safe, and requires improvement for effective and well led. Caring and responsive were not rated. The specific issues that were found to be in breach of CQC regulations were:

• The service did not hold training records for all staff, the only training that the service held for the person assisting with the surgery was child safeguarding (which was not at a sufficient level) and fire safety.
• Clinical records at the service were not contemporaneous. The service utilised a proforma template which was amended as required. However, in some cases actions were not clearly recorded.
• The service did not minute its meetings and there were no formalised means by which issues such as significant events and safeguarding could be discussed.
• The service did not have a robust system in place for checking the identity of patients' parents. As a consequence, they could not be assured that consent had been adequately requested, and if a safeguarding referral was required, they could not be assured that it was correctly made.
• The service provided a letter to GPs after the procedure but did not retain a copy of this on the clinical record.
• The service did not record the batch number or dosage of local anaesthetics used during circumcision procedures.
• The service did not have a formalised significant events system.
• The service did not consistently ask for the consent of all those with parental responsibility and did not check their identification. Where the patient ought to have been asked for consent, this was not recorded.

Following the inspection of 28 August 2019, the practice was placed into special measures.

We carried out an announced comprehensive inspection at Transcend Consulting Rooms on 22 October 2020. We are mindful of the impact of COVID-19 pandemic on our regulatory function. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so. Following this inspection, the key questions are rated as:

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Good

At this inspection we found that the practice had addressed all of the issues from the previous inspection.

We found that:

• The service provided care in a way that kept patients safe and protected them from avoidable harm.
• Patients received effective care and treatment that met their needs.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The service organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.
• The way the practice was led and managed promoted the delivery of high-quality, person-centre care.

The areas where the provider should make improvements are:

• The service should review the current process of utilising family members as translators.
• The service should review the process and storage of information sent to the service by patients post-operatively.

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