D-Restricted Ltd

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

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 6 quality statements for this key question, and it has been rated as outstanding.

This meant services were tailored to meet the needs of individuals and delivered to ensure flexibility, choice and continuity of care.

The service was exceptional at making sure people were at the centre of their care. They had an exceptional understanding of the diverse health and care needs of people. Care was joined-up, flexible and supported choice and continuity. Information provided was tailored to caregivers’ individual needs. They always involved people in decisions about their care. The service was exceptional at ensuring people could access the care, support and treatment they needed when they needed it. The registered manager actively listened to information about people who were most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this.

We have not awarded this service a score for Responsive.

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

We scored the service as 4. The evidence showed an exceptional standard. The service was exceptional at making sure people were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

Care plans were holistic and reflected each family’s physical, emotional, mental and social needs, including needs linked to protected characteristics. The pre‑assessment process identified any individual issues or access needs. The registered manager (RM) contacted caregivers in advance to ensure assessments could be tailored to meet their needs. Recognising the gap in post‑procedure support, the provider introduced a comprehensive 6‑week package offering feeding reviews, tongue‑function checks and emotional wellbeing support, alongside weekly groups and an online support community. This ensured families received continuous, holistic care before, during and after the frenulotomy procedure.

Families who had specific needs shared examples of how the RM had personalised their treatment plan. For example, working closely with caregivers to increase infants’ weight and supporting caregivers’ mental wellbeing. Caregivers we spoke to described the approach as very supportive and personalised.

Caregivers were fully involved in assessment and treatment decisions. The RM gathered information from caregivers and regularly checked in with them to make sure they understood the treatment plan or to confirm they agreed with the assessment and next steps. They were encouraged to participate during the procedure and feeding assessment, ensuring care was truly family‑centred and decisions were shared. For example, caregivers were invited to support and hold the infant still during the procedure and were offered support and encouragement to feed their infant immediately following the procedure. The RM was fully inclusive of all caregivers during the appointment. They sought their opinion about how they felt the procedure went and what improvements they had observed. For example, the primary and secondary caregivers we spoke to had felt fully involved during the assessment.

After the procedure, the RM ensured infants were feeding effectively and caregivers felt confident. Immediate feeding was encouraged to provide comfort and control bleeding, and caregivers received tailored support to optimise attachment, positioning and tongue movement. Alternative techniques were demonstrated when needed, and support continued until the infant fed well and the caregiver felt confident. Families were encouraged to be fully involved in post‑procedure feeding.

We scored the service as 4. The evidence showed an exceptional standard. The service had an exceptional understanding of the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

The RM recognised the diverse needs and inequalities within the local communities they served. They worked in partnership with other local services and supported areas where there were unmet needs to assess and treat infants who had a tongue tie. The RM was able to describe the demographic makeup of the areas they served and knew what support was available to families. The RM had developed local networks in these areas of other services and promoted tongue tie awareness to them, as well as raising awareness with local GP practices.

The service was flexible and joined up, providing continuity of care and treatment. Appointments were offered at flexible times to meet the needs of caregivers' and infants'. For example, appointments could be booked around caregivers' work commitments. Furthermore, the RM supported caregivers' to book appointments around feeding times, so they had enough time to observe feeding as part of the assessment process and support post frenulotomy feeding. The service worked well with other local services such as infant feeding support, health visitors, GPs and midwives. The RM routinely updated these services about their patients' assessment outcomes and the treatment given.

The service provided 6 week follow up support through text messaging, email, telephone and face to face support through a group and when required through follow up appointments. The support package was 6 weeks but the follow up group was offered beyond this. People told us the RM often provided support beyond the 6-week period.

Care and treatment was delivered in a way that met caregivers' and infants' assessed needs because the service was co-ordinated and responsive. Where there were concerns, we saw examples where the RM contacted other services to agree a joined-up plan to best support and optimise the outcome for the infant. In complex cases, the RM ensured care aligned with agreed support plans before carrying out the frenulotomy.

We scored the service as 4. The evidence showed an exceptional standard. The service was exceptional at developing appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

Information provided by the service was clear, comprehensive and accessible, enabling families to understand tongue tie, treatment options and associated risks. Caregivers consistently praised the RM’s expertise and the extensive online resources available. For example, they told us the RM had an ‘excellent level of knowledge’ and ‘there is a lot of useful information on the online portal’.

Information was tailored to individual needs and people who had difficulty with reading, writing or using digital services were supported with accessible information. Caregivers’ individual communication and accessibility needs were identified at booking, reviewed and ensured information was provided in line with the accessible information standard. Information was available in multiple formats and languages, the service’s website and portal included an accessibility widget with options such as larger font, contrast settings, read aloud and translation tools.

The RM adapted their communication style to meet individual needs, offering information in written, pictorial and video formats. They used models and visual aids in clinic to support understanding. Caregivers told us this made information clear and helpful. The caregivers we spoke with provided positive feedback about the patient portal. One caregiver told us, ‘there is tons of useful information’ and another said, ‘I found it useful to refer back to the portal information which was really helpful’.

People who used the service, were provided with information that was accessible, safe and secure and supported their rights and choices. Caregivers accessed a secure online portal containing their pre‑assessment, detailed information about tongue tie, feeding, the frenulotomy procedure and post‑procedure guidance. Records, photographs and clinical notes were uploaded on the portal immediately, giving families direct access to everything discussed. Information on privacy, confidentiality, consent, refunds and consumer rights was also available.

Data protection requirements were met through an up‑to‑date record‑keeping and data‑retention policy and a privacy policy. The cancellations and refund policy had been reviewed in January 2026, and we saw examples where caregivers received refunds when the assessment did not proceed to frenulotomy.

We scored the service as 4. The evidence showed an exceptional standard. The service was exceptional at enabling people to share feedback and ideas, or raise complaints about their care, treatment and support. They always involved people in decisions about their care and told them what had changed as a result.

People were actively involved in improving the service. Feedback from people who had used the service highlighted limited local support after the frenulotomy procedure, so the RM introduced a 6‑week support package, an online patient portal, a social media support group and a weekly face to face feeding group, all at no extra cost. Caregivers also requested access to weighing scales, which were made available at both the clinic and support group, to give caregivers additional reassurance about their infant’s progress.

People understood how to give feedback or raise concerns through several accessible routes. The complaints policy, which was available on the provider’s website, had been recently reviewed and clearly outlined the process for complaints, including the timescales in which they could expect a response from the provider, and escalation options, including referral to an independent ombudsman. Caregivers were given information at their assessment appointment, along with quick access (QR) codes for feedback to the provider, and CQC feedback cards.

Caregivers felt confident that if they complained, they would be taken seriously and treated compassionately. Caregivers told us they felt comfortable approaching the RM, who listened openly and responded constructively. They felt the RM was open and transparent in their approach and listened to feedback.

The service had not received any complaints in the 12 months prior to our inspection. Feedback from families, both during our inspection and through online reviews was overwhelmingly positive.

We scored the service as 4. The evidence showed an exceptional standard. The service was exceptional at ensuring people could access the care, support and treatment they needed when they needed it.

People could access care, treatment and support quickly in a way that worked for them. There were no waiting lists, and appointments were available immediately on booking. The service operated Monday to Saturday, offering up to 24 appointments per week, with urgent requests often accommodated at short notice. For example, on the day or within 24-hour bookings. Appointment times were flexible, could be rearranged without charge, and people told us they were usually seen within 1–2 days of booking. The service aimed to see people within 5 days and consistently met this. Of the 340 frenulotomy procedures carried out in 2025, all were booked within 5 days. The provider signposted people to the Association of Tongue tie Practitioners (ATP), enabling families to secure a more convenient appointment where necessary, increasing choice and convenience.

The service was flexible in meeting different needs. Where barriers to access were identified, the RM contacted the caregiver to agree reasonable adjustments to ensure their needs. For example, they offered evening and weekend appointments for working caregivers. Home visits were offered for those unable to attend due to mobility, or with other access needs.

Care was delivered in line with best practice, with appointments long enough to allow a post‑procedure feed so the provider could ensure infants were feeding safely, a support caregivers described as, “invaluable”.

People could access service without physical or digital barriers The clinic offered step‑free, ground‑floor access, wheelchair accessibility and on‑site parking. The online portal was fully accessible, with translation tools, screen‑reader compatibility, and an accessibility widget for neurodivergent users or those with dyslexia.

We scored the service as 4. The evidence showed an excellent standard. The RM actively listened to information about people who were most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this.

The provider complied with legal equality and human rights requirements by taking active steps to avoid discrimination, considering the needs of people with different protected characteristics, and making reasonable adjustments to promote fair and consistent experiences and outcomes. The provider had an equality, diversity and inclusion (EDI) policy. The purpose of the policy was to ensure compliance with the Equality Act 2010 and to embed a culture of inclusion, fairness and respect for all people using the service and for external stakeholders. The RM demonstrated an awareness of how inequalities could affect people’s experiences and outcomes and took practical steps to ensure assessments, treatment and support was responsive to individual needs.

The RM proactively sought training to strengthen their understanding of discrimination, inequality, and the barriers that may affect different groups’ ability to access services. This included recent training on ethnicity, diversity and human rights, as well as learning in disability and autism awareness, and mental health awareness. This learning supported their commitment to ensuring people from all backgrounds could access the service without disadvantage and that care was delivered in a fair, inclusive and responsive way.

The RM complied with legal equality and human rights requirements, including avoiding discrimination and having regard for the needs of people with protected characteristics. Outcome audits included demographic analysis, showing 20% of people using the service in 2025 were from minority ethnic backgrounds. The RM completed specialist training on breast assessments in diverse skin tones to improve equity in infant feeding assessments. These actions supported culturally responsive, person‑centred and clinically informed tongue tie assessment and treatment.

The service was alert to discrimination and inequality that could affect infant and caregiver’s experiences, ability to access the service and outcomes. They proactively considered how different groups such as same‑sex parents, families from minority ethnic backgrounds, and people with additional health or communication needs might experience barriers to assessment or support.

We did not look at Planning for the future during this assessment. There is no previous rating for the Responsive key question so we cannot yet publish a score for this area.