D-Restricted Ltd

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

We looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

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 outstanding. We assessed 5 quality statements for this key question and has been rated as outstanding.

This meant service leadership was exceptional and distinctive. Leaders and the service culture they created drove and improved high-quality, person-centred care.

The service had a shared vision, strategy and culture. The service had an exceptionally inclusive leader who understood the context in which they delivered care. The service understood and carried out their duty to collaborate and work in partnership. The service had clear responsibilities, roles, systems of accountability and good governance. The service had a strong focus on continuous learning, innovation and improvement and local system. They always encouraged creative ways of delivering equality of experience.

We have not awarded this service a score for Well-led.

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

We scored the service as 3. The evidence showed a good standard. The service had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of patients and their communities.

The service had a clear vision and strategy for the service which described its aim to deliver highly skilled, compassionate and evidence-informed support in infant feeding. Central to the vision was providing personalised aftercare and promoting a family approach to the infants feeding journey. Underpinning this was the drive to support people to maintain their human rights and improving access to the service. It was evident through observations of care and feedback from people that had used the service, the RM delivered their vision and was committed to improving outcomes for infants and caregivers and improving access to treatment that benefited the wider community.

The RM proactively identified and managed risks to achieving the service’s strategy. For example, in recognising the potential impact of a reduction in statutory tongue tie provision, they responded by expanding their geographical reach and developed an education and training package that to promoted best practice to support the development of new and existing tongue tie practitioners. This forward‑thinking approach strengthened service sustainability and further advanced their goal of becoming a national leader in tongue tie care.

We scored the service as 4. The evidence showed an exceptional standard. The service had an exceptionally inclusive leader who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. The RM had the skills, knowledge, experience and credibility to lead effectively. They always did so with integrity, openness and honesty.

The RM owned and operated the service full time and had the skills, experience and integrity to deliver the organisation’s vision and manage risks effectively. They were highly trained in tongue tie, having completed accredited competency‑based training and achieving certification as a lactation consultant. They had also undertaken leadership, management and train‑the‑trainer qualifications to support service development.

The RM was visible, led by example and modelled inclusive behaviours. They demonstrated national leadership skills by becoming an honorary Association of Tongue Tie Practitioners (ATP) member and developing a specialist training programme. Through this, they contributed to best-practice guidelines and supported other practitioners in developing their services. They attended regional forums and participated in national and international conferences to keep their practice current. They were also a member of an international tongue tie consortium of oral ankyloglossia specialists.

The RM had a good understanding of priorities involved to ensure they delivered a high-quality service and could access appropriate support and development in their role. Policies and procedures were aligned with national guidance and governance systems ensured effective oversight of them. They sought advice from peers when needed and remained knowledgeable about service quality priorities, ensuring appropriate professional support and development was accessed. They took time to ensure caregivers were happy with the service they had received. The RM understood service risks and challenges they could face with clear oversight of these and plans to mitigate risks.

The service had expanded to increase awareness of tongue tie and improve access, offering flexible appointments 7 days a week. The RM had access to satellite clinics in Leicestershire and Birmingham and was securing an additional East Midlands location. They strengthened sustainability by providing an accredited training course in tongue tie, feeding support and baby yoga. Local professionals, including health visitors and midwives, spoke highly of the RM, and feedback was positive.

We did not look at Freedom to speak up during this assessment. There is no previous rating for the Well-led key question so we cannot yet publish a score for this area.

We did not look at Workforce equality, diversity and inclusion during this assessment. There is no previous rating for the Well-led key question so we cannot yet publish a score for this area.

We scored the service as 3. The evidence showed a good standard. The service had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver good quality, sustainable care, treatment and support. They act on the best information about risk, performance and outcomes, and share this securely with others when appropriate.

Governance processes were used to manage and deliver high quality, sustainable care, treatment and support. A clinical risk management and quality assurance policy, reviewed in January 2026, set out how the service oversaw risk, quality, incidents, complaints and compliance with legal and regulatory standards. The RM had a good understanding of their responsibilities and ensured systems were embedded to evidence compliance with the policy.

The RM implemented quality frameworks and recognised standards to ensure safety and improve equity in experience and outcomes. Policies and procedures were up to date, evidence based and reflective of best practice in tongue tie assessment and infant feeding support.

Quality assurance processes were established and consistently applied. The RM completed regular audits covering infection prevention and control, health and safety and clinical records. They addressed any identified issues promptly. Monthly reviews of outcome data, including maternal pain scores and feeding assessments, supported ongoing monitoring of service performance.

The service took a proportionate approach to risk management. The risk register was reviewed regularly by the RM. It included clinical, environmental and business risks, and documented how these risks were mitigated.

The RM maintained professional competence through specialist training and annual peer review. There were processes to share learning from incidents, concerns and compliments and they completed reflective accounts to support service improvement. Whilst no incidents were reported in the 12 months prior to our assessment, we found evidence of incidents having been reported prior to this and learning being identified and used to improve the service.

The RM submitted required data and notifications to external bodies and understood their responsibility to notify CQC of relevant events.

Arrangements for the availability, integrity, security and confidentiality of data were robust. The provider was registered with the Information Commissioners Office (ICO) in line with legal requirements under the Data Protection Act 2018. Records were stored securely on an electronic system. Permission was sought and documented electronically to share information directly with the infants’ GP and other professionals where required.

Sustainability was a priority and featured on the risk register. The service monitored demand, to ensure appointments, procedures and follow‑up care remained accessible without compromising safety or quality. Forward planning included maintaining financial viability by developing outreach services in wider geographical areas to increase service provision. There was a business continuity plan that detailed plans to manage emergencies and arrangements for cover in the event of unforeseen absence.

We scored the service as 4. The service clearly understood and carried out their duty to collaborate and work in partnership, and services worked seamlessly for patient. Staff always share information and learning with partners and collaborate for improvement.

The service built effective partnerships with key organisations that enhanced outcomes and experiences for infants and their caregivers. The RM actively engaged with a wide range of community partners to create joined up pathways of support for infants and caregivers. For example, they had established relationships with health visitors, midwives, feeding support services, GPs, paediatric and neonatal services, and other independent healthcare providers. These relationships enabled timely, coordinated care and strengthened the wider infant‑feeding community.

The service had effective partnerships that supported innovation and contributed to raising community awareness of tongue tie and infant feeding. They actively contributed to local and national improvements in tongue tie care, inviting student midwives, health visitors and other providers to observe practice and learn. They provided education, signposting and informal advice to community professionals, strengthening local capability. They developed an accredited theory‑based training package. The RM was passionate about raising awareness and this was widely recognised by caregivers and other services.

The service regularly shared specialist expertise and took part in multidisciplinary discussions, offering clinical guidance to partner organisations. The RM frequently liaised with midwives, health visitors and other specialists to ensure care was aligned, particularly where underlying health concerns were identified. This collaborative approach improved early identification of feeding issues, strengthened signposting and reduced delays for families. Partners consistently described the service as ‘knowledgeable’, ‘responsive’, providing a ‘joined up approach’ and the RM as being ‘open and respectful’.

The service actively sought feedback from caregivers, peer‑support groups and partner services to understand local needs and adjust service delivery. This led to flexible appointment options, improved post‑procedure support and more accessible information for families from diverse backgrounds. As a result, the service aligned well with local priorities for infant health, breastfeeding support and equitable access.

We scored the service as 4. The evidence showed an exceptional standard. The service had a strong focus on continuous learning, innovation and improvement across the organisation and local systems. They always encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contribute to safe, effective practice and research.

There were clear processes for continuous learning and examples where improvements had led to better patient experience and quality of care. For example, in response to caregiver feedback about limited post‑procedure support, the RM developed a 6‑week tongue tie package and invested in a patient portal to provide holistic, ongoing guidance. The package of support was developed with caregivers and infants in mind to ensure they continued to develop post frenulotomy.

The RM included people who used the service in developing and evaluating improvement and innovation ideas. The RM had designed and implemented a symptom monitoring checklist. These involved caregivers tracking improvements in their infant’s overall symptoms and feeding ability so outcomes could be measured overtime. The symptom checklist had been implemented in January 2026, but outcome data was not available at the time of our inspection.

There were systems to ensure learning from both positive practice and when things went wrong. Adverse events were reported externally to ensure independent oversight of risk. Observations of the RM were carried out by other practitioners to identify strengths and areas for development. Reflective accounts were routinely completed; for example, the RM reflected on a case where post‑procedure bleeding occurred after the family had left the clinic, identifying what worked well and what could be improved.

The RM prioritised improving their skills and practice around improvement and innovation. They regularly attended regional ATP meetings, and national and international conferences, adopting new learning to enhance assessments and to build support networks. For example, following international training, they incorporated detailed palate assessments to identify infants needing specialist referral.