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Inspection carried out on 30/06/2019

During a routine inspection

This service is rated as Good overall.

The service had previously been inspected in November 2017 and was found to be providing services in accordance with relevant regulations. However, at that time independent providers of regulated activities were not rated by the Care Quality Commission.

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

We carried out an announced comprehensive inspection at AMS Clinic Bradford on 30 June 2019 as part of our inspection programme.

The clinic provides circumcision to patients aged from two weeks up to two years of age for both cultural and religious reasons. Patients also have access to post-procedural reviews at the clinic and access to an aftercare helpline available 24 hours a day.

One of the directors of the clinic 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 clinic is run.

The clinic made use of patient feedback to monitor and improve the service. They produced their own surveys and regularly monitored feedback through google review.

In addition; we received nine Care Quality Commission comment cards. These were all very positive about the care delivered by the service.

Our key findings were:

  • The clinic was offered on a private, fee paying basis only and was accessible to people who chose to use it.
  • Circumcision procedures were safely managed and there were effective levels of patient support and aftercare.
  • The clinic had developed materials for parents which explained the procedure and outlined clearly the recovery process.
  • Parents received daily text messages providing advice for 13 days following the procedure to outline what to expect and give advice about aftercare.
  • The clinic had systems in place to identify, investigate and learn from incidents relating to the safety of patients and staff members.
  • There were systems, processes and practices in place to safeguard patients from abuse.
  • The clinic always communicated with the GP service with which patients were registered via letters sent with the parents following the procedure.
  • There was a clear leadership structure, with governance frameworks which supported the delivery of quality care.
  • Communication between staff was effective with regular documented meetings across both sites.

The areas where the provider should make improvements are:

  • Review and improve the process for communicating with the patient’s own GP following the procedure.
  • Review and improve the process for the documentation of medical indemnity and staff immunity status.
  • Review and improve the process for checking the oxygen supply.
  • Review the systems in place for direct clinical observation to assess surgical technique.
  • Review the arrangements for onsite access to the legionella risk assessment.

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

Inspection carried out on 12 November 2017

During a routine inspection

We undertook an unannounced responsive focused inspection of AMS Clinic on 19 March 2017. This was in response to information of concern received by the Care Quality Commission regarding infection control, privacy and consent. During this inspection we identified a breach of regulation 12 (safe care and treatment) as there were concerns regarding infection prevention and control processes in the basement area where surgical procedures were carried out. As a result of this inspection the provider submitted an action plan within 48 hours and provided assurance that the issues would be rectified prior to the next clinic being held on 26 March 2017. We also received photographic evidence to demonstrate that works had been undertaken to address the issues.

We undertook a further inspection of AMS Clinic on 12 November 2017. This was an announced comprehensive inspection to look at the improvements that had been made following our March 2017 inspection. We also asked the service provider 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.

AMS Clinic Limited is an independent circumcision provider which is registered in Bradford, West Yorkshire to operate from locations in Bradford and Manchester. The Bradford based service registered with the Care Quality Commission to provide surgical procedures on 27 February 2014. The service provides circumcision to infants aged from two weeks old to adulthood for cultural and religious reasons under local anaesthetic. The service carries out post procedural reviews of patients who have undergone circumcision at the clinic.

The service operates from premises at 72 Oak Lane, Bradford, West Yorkshire, BD9 4QX. The clinic is set across four floors. The reception and waiting area is located on the ground floor, with a dedicated private room for obtaining consent situated behind this area. Surgical procedures are carried out in the basement area of the clinic. Following the procedure, patients are taken to private consultation/waiting rooms on the first floor and second floor to recover from treatment.

The service is led by three directors (male) who have each been identified a specific area to lead on. The registered provider is the managing director and is also responsible for registration with the Care Quality Commission.

The clinic operates from the Bradford site from 10am until 3pm on Sundays.

The service is delivered on a rotational basis by a consultant urologist, a consultant from the local secondary care accident and emergency department and a secondary care accident and emergency nurse who are all employed by AMS Clinic to carry out the procedure. The clinicians are all trained and experienced in circumcision and carry out the procedure on a regular basis. A second member of staff supports the clinician during each procedure and this role is carried out by an experienced nurse or healthcare assistant.

The reception area is covered by an additional nurse or health care assistant who explains the procedure to patients and/or parents, carries out a pre-operative assessment to confirm that the patient and mother are in good health, and obtains consent prior to the procedure taking place.

The service provides a 24 hour helpline which is accessible from the time of booking the appointment and also to deal with any concerns following the procedure.

In addition, the clinic sends daily text alerts to the patient or the parents of the patient for two weeks following the procedure to give prompts and advice.

Our key findings were:

  • The service was offered on a private, fee paying basis only and was accessible to people who chose to use it.
  • Circumcision procedures were safely managed and there were effective levels of patient support and aftercare.
  • The service had systems in place to identify, investigate and learn from incidents relating to the safety of patients and staff members.
  • There were systems, processes and practices in place to safeguard patients from abuse.
  • Information for service users was comprehensive and accessible.
  • Patient outcomes were evaluated, analysed and reviewed as part of quality improvement processes.
  • Staff had the relevant skills, knowledge and experience to deliver the care and treatment offered by the service.
  • The clinic shared relevant information with others such as the patient’s GP and when required safeguarding bodies.
  • There was a clear leadership structure, with governance frameworks which supported the delivery of quality care.
  • The service encouraged and valued feedback from service users via the website and conducted random surveys at clinics at least eight times a year.
  • Communication between staff was effective with regular documented meetings across both sites.

There were areas where the provider could make improvements and should:

  • Document a risk assessment for transporting patients from the basement area to the first floor following the procedure.
  • Carry out works to seal the junction between the window and wall in the surgery room.
  • Review and look to improve the process for checking the identity of parents and obtaining proof of parental authority.

Inspection carried out on 19 March 2017

During an inspection looking at part of the service

We carried out an unannounced responsive focused inspection on 19 March 2017 to establish whether services delivered by AMS Clinic Ltd were safe.

Our findings were:

Are services safe?

We found that this service was not providing safe 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 following concerns around infection prevention and control, privacy and consent.

The AMS Clinic Ltd is located at 72 Oak Lane, Bradford, West Yorkshire, BD9 4QX. 

The clinic was set across four floors. The reception and waiting area was located on the ground floor, with a dedicated private room for obtaining consent situated behind this area. Surgical procedures were carried out in the basement area of the clinic. Following the procedure, patients were taken to private consultation/waiting rooms on the first and second floor to recover from treatment.

The AMS Clinic Ltd operates from two locations, the second location being based in Manchester. We did not visit this location as part of our inspection.

The AMS Clinic is a private provider of circumcisions for boys from aged 2 weeks upwards to adults.

The service is primarily provided on Sunday mornings from 10.15am, with the option of afternoon clinics to accommodate demand where necessary.

The service is delivered by two doctors, two registered nurses and three healthcare assistants who operate on a rota basis. The usual staffing on a session consisted of a doctor supported by a healthcare assistant . The reception area is covered by an additional nurse or health care assistant who explained the procedure to patients, carried out a pre-operative assessment, to confirm that the patient and mother were in good health, and obtained documented consent prior to the procedure taking place.

The service also provided a 24 hour post-operative helpline number to deal with any concerns following the procedure.

As this was an unannounced inspection we did not request any feedback from patients in advance of, or during the inspection.

Our key findings were:

  • The provider had systems in place to obtain and document consent prior to any procedure taking place.
  • Parents were not usually present during the procedure. However; there was a health care assistant present during every procedure to act in the role of a chaperone. A chaperone is a person who serves as a witness for both a patient and a medical practitioner as a safeguard for both parties during a medical examination or procedure. There was a television in the waiting area. This was to aid confidentiality and reduced the likelihood of conversations being overhead from the consent room located behind the reception/waiting area.
  • We found the clinic to be clean and well maintained in the majority of areas. However; we found some significant issues with the infection prevention and control systems in the surgical procedures room located in the basement area.

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

  • Ensure that the basement area meets infection prevention and control requirements for a surgical area.
  • Due to the risks associated with the infection prevention and control issues, we contacted the provider following our inspection and requested that an action plan be submitted within 48 hours. The provider complied with this request and provided assurance that the issues identified would be rectified prior to the next clinic being held on 26 March 2017. We also received photographic evidence to demonstrate that works had been undertaken to address the issues identified prior to the next clinic being held.