The NHS' specialist clinic for children with gender dysphoria has been graded "inadequate" by the Care Quality Commission (CQC).
The Gender Identity Development Service (GIDS) is operated by the Tavistock and Portman NHS Trust, and has come under fire recently over prescriptions of puberty blockers and other controversial forms of medical treatment for young people with gender dysphoria.
It was graded 'inadequate' following an inspection by the CQC late last year, the Guardian reports.
Inspectors cited poor leadership and said that some staff had "felt unable to raise concerns without fear of retribution".
Inspectors also criticised record-keeping at the clinic, which they said had failed to properly document "the competency, capacity and consent" of patients going forward for medical intervention.
The grading follows the recent High Court case involving Keira Bell, 23, who received puberty blockers at GIDS aged 16 before progressing to cross-sex hormones and undergoing a double mastectomy.
In a landmark judgment, the High Court said it was "highly unlikely" children 13 and under could give genuine consent, and that a court ruling should be sought before proceeding with a medical transition.
