D-Restricted Ltd

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

We looked for evidence that the service involved people and treated them with compassion, kindness, dignity and respect.

This is the first assessment for this key question under its current registration. However, the key question was previously rated under a different registration as good. We assessed 4 quality statements for this key question, and it has been rated as outstanding.

This meant people were truly respected and valued as individuals; and empowered as partners in their care in an exceptional service.

The service was exceptional at treating people with kindness, empathy and compassion. They treated people as individuals, always meeting their needs and preferences. The service was exceptional in how they listened and understood people’s needs, views and wishes and they promoted independence, so they had control over the care received. The registered manager responded to people’s needs in the moment and acted to minimise any discomfort, concern or distress.

We have not awarded this service a score for Caring.

Find out about when we will not publish a key question score and what we look at when we assess Caring.

We rated the service as 4. The evidence showed an exceptional standard. The service was exceptional at treating people with kindness, empathy and compassion and in how they respected people’s privacy and dignity. The registered manager always treated colleagues from other organisations with kindness and respect.

The registered manager (RM) consistently demonstrated exceptional kindness, empathy and compassion. They communicated clearly, listened attentively and provided reassurance throughout the assessment and procedure. We observed the RM to be kind and caring throughout all interactions, particularly in providing reassurance about the procedure and in supporting caregivers to feed their infant.

We received multiple positive comments about the kindness, compassion and empathy received from the provider. For example, caregivers described the RM as, ‘warm and lovely’ and, ‘a shoulder to lean on’. Other comments included, ‘she was a lifeline who saved my sanity’ and ”[name of RM] supported my emotional wellbeing”. We observed the RM taking time to soothe and calm infants prior to the procedure and using the infant’s own blankets to swaddle them. One caregiver told us their infant was, ‘less distressed’ following their procedure in comparison to their other children, who had the procedure elsewhere, which they said was ‘because of the [RMs] calm and reassuring approach’.

Care was compassionate and personalised, with extensive follow‑up support. The RM took time to understand each family’s needs and helped them make informed decisions about whether and when to proceed with frenulotomy. Appointments were rebooked when needed to ensure safety and confidence. Post‑procedure support was offered at no extra cost, including an instant‑messaging service, a closed online group and a weekly in‑person support group. Caregivers told us this ongoing support was invaluable in improving feeding, tongue function and family wellbeing. One caregiver told us, ‘she saved us, our first meeting was a turning point.’

The RM involved caregivers throughout, regularly checking their understanding and comfort. Caregivers felt their needs were responded to quickly, particularly when they were anxious, in pain or struggling with feeding. They praised the rapid response to bookings, direct messaging, and the tailored follow up plan.

Caregivers felt the RM knew them well and understood their preferences and circumstances. Many described the service as going ‘above and beyond’. Ongoing contact through calls, messages, support groups and additional appointments, all without extra charge, meant families received continued personalised support after the procedure.

Dignity was central to the service’s culture and was consistently maintained. Caregivers were assured that information about them was treated confidentially. Caregivers told us, ‘my privacy and dignity was maintained 100%’, and the RM was ‘professional and mindful of my privacy at all times which was comforting’. During our observations, the RM checked whether caregivers were comfortable and offered to close blinds during breastfeeding assessments.

The service had a privacy policy that reflected national guidance. Information about people was stored electronically on a secure case management system.

There was a culture of kindness and respect between colleagues from other organisations. Professionals we spoke to praised the RM’s communication and willingness to share expertise.

We rated the service as 4. The evidence showed an exceptional standard. The service treated patients as individuals and was exceptional in how they made sure patient’s care, support and treatment always met patient’s needs and preferences. The service took account of patient’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

There were processes to identify caregivers’ personal, cultural, social and religious needs. The pre‑assessment captured any communication, emotional or physical requirements so arrangements could be made to meet these needs before the first appointment. For example, this enabled the RM to book interpreters or identify and remove barriers to access.

The RM demonstrated a strong understanding of individual preferences and provided examples of tailoring care accordingly. They took time to understand neurodivergent needs, adapting how information was presented and allowing caregivers additional time to process information before proceeding. The RM told us how they had made improvements to support individual preferences. For example, they changed the assessment and consent form to parent 1 and parent 2 from mother and father in recognition of inclusion of different family types.

Reasonable adjustments were made when caregivers faced barriers to attending the clinic. The premises were wheelchair accessible, however, if this was not convenient, the RM offered home assessments to make the service more inclusive where needed.

People were treated as individuals, with care tailored to their specific goals and circumstances, including protected characteristics. For example, the RM worked closely with same‑sex parents to create personalised feeding plans post‑procedure. They also adapted guidance for breastfeeding caregivers who were fasting for cultural or religious reasons to ensure feeding remained safe and effective.

Caregivers’ communication needs were proactively assessed and met to maximise good engagement and positive outcomes. The RM had a strong awareness of the importance of adapting to meet the communication needs of caregivers. They ensured information was available in multiple formats, and the website and portal included functions to translate, read aloud and to change fonts and colour. Interpreters, including for British Sign Language, could be arranged in advance when required. The RM presented information in different formats to increase engagement. For example, they used photographs and videos to support people who understood better through seeing. The RM had also purchased equipment to help support understanding of tongue tie and the frenulotomy procedure. For example, a model of tongue anatomy to visually educate caregivers and demonstrate exactly how restricted tongue movement affects an infant’s ability to latch, suck, and transfer milk. The model was available to guide aftercare where required.

Appointments were 90 minutes long to ensure there was sufficient time to allow caregivers to process information and carry out the procedure.

We rated the service as 4. The evidence showed an exceptional standard. The service was exceptional at promoting patient’s independence, so patient knew their rights and had choice and control over their own care, treatment and wellbeing.

Caregivers were fully supported to have choice and control over their infant’s care. Clear information about tongue tie, feeding challenges and the procedure was shared before the appointment, enabling informed decisions. During the assessment, the RM used a range of communication methods, including visual demonstrations of tongue function to help caregivers decide whether to proceed with the frenulotomy procedure.

Following the appointment, caregivers were provided with quick response (QR) codes to give them quick access to information to support them after the frenulotomy procedure to continue to develop their infants tongue function and feeding ability.

Interactions were family‑centred, and caregivers were given time to process information and make decisions they were comfortable with.

The RM included caregivers at every stage, including in decisions about how they wished to comfort and support their infant during the procedure.

People were supported to understand their rights by using different ways to communicate. Information was provided in multiple formats to meet different communication needs, and understanding was checked throughout the appointment. Caregivers had several routes to give feedback, including giving online reviews, direct feedback to the service and completing outcome measures after the procedure. Including feedback about changes in pain to breastfeeding caregivers, and changes in infants feeding behaviour.

The RM fully involved caregivers and those close to them to seek and maintain access to peer support. All caregivers were invited to a social media support group and a weekly face‑to‑face group, where they could speak with the RM and connect with other families. Caregivers were overwhelmingly positive about the follow up support and ability to connect with other caregivers in a similar situation. They told us they found this support invaluable. The RM also signposted to local infant feeding support services when needed.

We rated the service as 4. The evidence showed an exceptional standard. The service was exceptional in how they listened to and understood people’s needs, views and wishes. The registered manager responded to people’s needs in the moment and acted to minimise any discomfort, concern or distress.

The service consistently prioritised caregivers’ and infants’ needs, wishes and comfort. The RM responded quickly to concerns from caregivers from the point of booking onwards. They understood caregivers might be anxious and overwhelmed by their infants’ feeding concerns and associated problems like weight loss. They promptly reviewed new referrals and contacted the caregivers when needed. During the first appointment, the RM made regular opportunities for caregivers to ask questions, and to check their understanding of the information being presented and offer them reassurance and support. Caregivers told us the RMs approach was, ‘warm’ and ‘comforting’ and they felt they were listened to and understood.

Risks were explained in a balanced and sensitive way, recognising that caregivers might feel anxious or overwhelmed. Appointments lasted up to 90 minutes, allowing time for a thorough assessment, clear explanations and observations of infant feeding before and after the frenulotomy. This enabled the RM to develop a holistic understanding of each family’s needs and respond in a way that respected their preferences.

Caregivers told us the RM was highly responsive to requests for help and acted quickly to meet needs. They received hands‑on support with feeding during appointments and could access prompt guidance afterwards through an instant messaging service, which families described as exceptionally responsive. The RM was also quick to identify when urgent or specialist support was required. Face to face follow up support was offered through a support group.

The service had created a highly supportive and sensory-friendly environment to reduce anxiety by helping to regulate the infant’s nervous system while simultaneously reducing stress for caregivers. For example, calm lighting, soft music and sensory aids were available and used to promote relaxation for the infant and caregivers. There was a couch to enable a comfortable environment for caregivers to feed the infant. To increase comfort and confidence privacy was maintained during feeding with closeable blinds.

We did not look at Workforce wellbeing and enablement during this assessment. There is no previous rating for the Caring key question so we cannot yet publish a score for this area.