Feeding UnTied Limited

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

This means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

This is the first assessment for this new location. At our last assessment we rated effective as good. At this assessment the rating has remained good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

We reviewed all 6 quality statements for effective. This included assessing needs, delivering evidenced based care and treatment, how staff, teams and services work together, supporting patients to live healthier lives, monitoring and improving outcomes and consent to care and treatment. We found:

There was evidence of the registered manager ensuring their knowledge was kept up-to-date and in line with national updates.

There was evidence that the registered manager carried out reflections with a peer as part of revalidation with Nursing and Midwifery Council (NMC).

The registered manager had robust processes in place for ensuring consent was embedded into the service, including before the examination the procedure being carried out.

People received care, treatment and support that was evidence-based and in line with national frameworks.

There was evidence of the registered manager reviewing their processes and practices to ensure this was in the best interests of the baby.

The registered manager provided tailored practical support to caregivers, so they understood how to support their baby following the procedure. People’s feedback described the service as “exceptional” and “distinctive”.

We saw the registered manager providing treatment options for caregivers if additional support was needed to improve feeding. This included the practice of craniosacral therapy, which the service used as a complementary approach to help alleviate symptoms such as an overwhelmed and shocked central nervous system, neck, jaw or shoulder stiffness, colic, digestive discomfort, and sleep difficulties. Craniosacral therapy is not regulated by the Care Quality Commission (CQC).

We have not awarded this service a score for Effective.

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

We scored the service as 3. The evidence showed a good standard. The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

The registered manager implemented a comprehensive health questionnaire for each baby, incorporating tailored support based on any individual needs identified by the baby or their caregivers. The questionnaire included a dedicated section for additional questions, enabling caregivers to highlight any communication, religious, or cultural needs. The registered manager included in the health questionnaire whether the caregiver or partner had any disabilities so their individual needs could be supported on the day of the appointment.

Individualised assessments considered the baby and caregivers health, care, wellbeing, and communication needs, to enable them to receive care or treatment that had the best possible outcomes. We observed a completed comprehensive assessment of the baby, which included an up-to-date medical and birth history of both the baby and mother. At the first appointment they reviewed the assessment and asked further questions, observed feeding techniques and undertook a physical examination of the mouth and tongue anatomy. The registered manager checked that the caregiver understood the process and allowed time for questions.

During our assessment, we observed a frenulotomy procedure being carried out. They used evidence-based tools to appropriately assess if the procedure should be carried out and observed the effectiveness of the procedure post-surgery. The registered manager used the Hazelbaker assessment tool to assess both the visual and functional mobility of the tongue.

There were systems and processes in place for specialist referrals in cases where an abnormality was found or when further investigations were needed. If babies had complex medical needs or unusual oral anatomy, they were referred to NHS services for a further review.

We saw the registered manager considering the emotional needs of the caregiver and offering reassurances before, during and following the procedure. After the meeting, one caregiver said that the registered manager "explained everything thoroughly and gave us a lot of reassurance throughout”.

We reviewed 5 case records records. The provider kept, clear, detailed, person-centred notes. There was evidence of all areas of the assessment being completed, with actions in place to support the needs of the baby following the appointment. Information from the assessment was stored on a secure system.

People were highly positive about the assessment process, explaining that they were given plenty of time to understand each stage clearly. Caregivers reported that the registered manager carried out a thorough and detailed assessment of their needs. One person said that the registered manager “explained everything in detail and made us feel part of the assessment”.

The registered manager was focused on providing advice and support and would signpost caregivers as needed to other services, which included access to support outside of the county if needed.

We observed the registered manager taking time to assess the baby’s progress after the procedure, including checking how effective the intervention had been. This involved closely observing feeding and offering tailored suggestions to help improve comfort and technique.

There was a process in place that provided caregivers with the opportunity to contact the registered manager to review any concerns with feeding following the procedure. One person said, "I was also given contact details if I had any questions, which reassured me that I could return if I had further concerns”.

The assessment was fully inclusive of the primary caregivers in identifying any unmet needs or support they might need to effectively feed their baby post division. A separate booklet was given to families explaining what to do if bleeding happened after the procedure. It described the registered manager’s role, the risks linked to low Vitamin K, and how to manage any extra bleeding at home. The information helped families know when they should get further help. The booklet also included references to show where the information came from, so caregivers could see it was based on evidence. People said the registered manager delivered outstanding feeding advice, helping them use the most effective techniques to support safe and successful feeding. One person said after the procedure the registered manager “watched as baby fed and gave us more info on how to maximise the feeding process. It was the best feed she had ever had”.

We scored the service as 3. The evidence showed a good standard. The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

People received care, treatment and support that was evidence-based and in line with National Guidance. The registered manager followed the National Institute for Health and Care Excellence (NICE) and Association of Tongue-tie Practitioner’s (ATP) guidance for division of ankyloglossia (tongue-tie). The registered manager regularly attended training and conferences that included national and international events, which provides updates to their policies and procedures. People said that the registered manager spoke about evidenced based research and how this guided their decision making. One person said, “I chose Feeding UnTied because of the evidence‑based information on the website, everything was evidence‑based and they had excellent knowledge”.

The registered manager was experienced, qualified and had the right skills and knowledge to meet the needs of babies. They had completed a recognised frenulotomy training course and received regular updates.

The service had in-date policies that ensured safe and effective care in recommendation with guidance.

These policies were used widely in the UK tongue‑tie community. The registered manager had policies and protocols to support the delivery of their service. We reviewed these during our assessment and saw they reflected up to date guidance for tongue-tie.

The provider outlined the risks associated with the procedure and provided guidance on the website to support people to make a decision. There was information on the website that provided the risk of reformation and tongue exercises that would help prevent this from happening. During the assessment, we observed the registered manager explaining the outcome of the procedure to caregivers, including showing them the normal healing appearance of the site.

We observed the registered manager monitoring the feeding technique before and after the procedure. The service had a clear policy detailing how the feeding technique should be assessed, supporting safe and consistent practice. Caregivers were also provided with comprehensive guidance on effective breast and bottle feeding, both via the service’s website and before leaving the appointment.

The registered manager spoke about reflective practice, which included changing the age criteria for a re-division of a tongue-tie from 2 weeks to 6 weeks based on their own research and experiences. They also attended regular meetings with the ATP, which provided regular national updates and learning.

We scored the service as 3. The evidence showed a good standard. The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

The registered manager communicated with caregivers prior to their appointment to request that they brought the Personal Child Health Record (PCHR), also known as the ‘red book’. This provided background information that was helpful for the registered manager to deliver effective care. The health questionnaire asked for details of the professionals involved with the family, including the GP, health visitor, and, where applicable, any social worker, which helped with aftercare support.

The registered manager had a policy in place if there was a known or possible family history of blood‑clotting disorders. They would liaise with the baby’s GP and the local haematology team to ensure it was safe for the procedure to be carried out or a referral for a specialist assessment would be more appropriate.

The registered manager worked with other tongue-tie colleagues to share information and any updates. They shared relevant information with GPs, NHS specialist infant‑feeding teams, and health visitors.

The service assessments included possible referrals to the hospital tongue-tie clinic for further investigations if needed or the GP and other specialist services. The registered manager provided an example of when they assessed laryngomalacia (noisy breathing), which led to a referral to the ENT (Ear, Nose, Throat) specialist for further investigations.

The registered manager worked collaboratively with other services to improve outcomes for people who used the service. Information was shared with other services to ensure continuity of care.

Following an appointment, a letter was sent to the GP to inform them that a frenulotomy procedure had been undertaken. The registered manager also provided to the family / caregivers an emergency letter if there were any post-operative complications. When information was sent to a GP following a consultation, the registered manager included an educational frenulotomy leaflet to support and improve understanding.

We scored the service as 3. The evidence showed a good standard. The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduced their future needs for care and support.

People were empowered and supported to manage their health, care and wellbeing. We observed the registered manager inviting questions from caregivers and ensuring they understood how to manage feeding and healing at home. One person said, “we felt comfortable asking questions throughout the appointment which meant we were able to leave feeling very informed and supported”.

We saw evidence that caregivers were actively involved in reviewing their baby’s health and wellbeing needs. The registered manager regularly discussed feeding progress, healing, and any concerns raised by families. Caregivers were given clear aftercare information and were told that they could contact the service if further support and guidance were needed.

The registered manager carried out a thorough assessment of each baby’s health needs and provided personalised support tailored to their individual circumstances. Caregivers received clear information on how to care for their baby following the procedure, including practical advice on reducing the likelihood of reformation.

A magazine was used throughout the consultation as a visual aid to support teaching and explanation. This resource provided practical guidance on infant feeding, including breastfeeding and weaning, and also held information specifically for fathers, with signposting to services to help them support their partners and families.

We scored the service as 4. The evidence showed an exceptional standard. The service monitored all people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they fully met both clinical expectations and the expectations of people themselves.

The registered manager had a system in place that tracked the number of completed assessments and if there were any re‑divisions or infection rates. This fed into national data and comparison between tongue tie services.

Performance was effectively managed through the monitoring of key risk and quality indicators related to the tongue‑tie procedure, including infection rates, excessive bleeding following frenulotomy, re‑division of tongue‑ties, and any post‑procedure infections. This performance data was shared with the Association of Tongue-tie Practitioners (ATP) to enable benchmarking against other tongue‑tie services nationally. Data provided by Feeding Untied Limited showed strong outcomes in 2025, with no excessive bleeding or post‑procedure infections recorded and reformation rates between 1–2%, which was 2–3% below the national average. In comparison, the most recent ATP national survey (2024) identified that over 4% of babies required a second frenotomy. This demonstrated that the provider consistently performed better than national averages across all monitored indicators

There were effective processes in place to monitor outcomes. Following the frenulotomy procedure, there was a period of observation to ensure the baby was able to feed successfully. The registered manager sent follow-up emails which asked families how the baby progressed after the procedure and requested updates on healing and feeding. This helped the service to monitor the baby’s recovery and identify any concerns that might require further support.

The registered manager also collected monthly and annual feedback reports to improve and adapt processes within the service. This meant continuous improvements were made to people’s care and treatment. The service had a process for annual audit checks, including adverse incidents forms, reformation audits and Infection Prevention and Control (IPC) audits. This showed a system of continuous quality assurance.

We scored the service as 3. The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centered care and treatment.

People were informed of consent to care when completing the health questionnaire prior to the appointment. We observed the registered manager checking whether caregivers had any questions before the procedure and confirmed they wished to proceed after the consultation. Clear explanations were provided throughout the assessment, which supported the caregiver to make decisions. The registered manager sought verbal consent before handling the baby or providing feeding support.

The provider created easy‑to‑understand leaflets and digital resources that explained the frenulotomy procedure in plain language. These materials helped caregivers understand what to expect before the consultation and offered practical information to support their decision‑making. The registered manager had processes in place for ensuring consent was embedded into the service, including before the examination and procedure was carried out.

Caregivers views and wishes were taken into account when babies care was planned. The registered manager explained what the tongue‑tie looked like, how it affected the baby’s tongue movement and showed these findings to the primary caregivers. Caregivers were involved in the assessment and information was provided to support them to make decisions as to whether they wished the procedure to happen. People we spoke with consistently said they were offered time and space by the registered manager to understand the outcome of the frenulotomy assessment before the procedure took place.

The service’s consent policy was up to date, reflective of current legislation and most up to date practice. It had been reviewed in June 2025. The consent form was in line with National Standards. It was included on the electronic assessment, which the registered manager asked the caregivers to sign following the assessment and before proceeding to the frenulotomy procedure.

Caregivers were asked to provide electronic consent for assessment and examination of the baby, consent for breastfeeding support and consent for bottle feeding support. On the day of the procedure, consent to proceed with the frenulotomy was obtained electronically, ensuring a transparent and consistent audit trail. This demonstrated a respectful approach and ensured caregivers remained fully informed.

Consent was gained for sharing information with the GP and health visitor as part of a standard procedure. The registered manager described an occasion where they encouraged a family member to seek a second consultation before proceeding with surgery, recognising they were uncertain about going ahead with the procedure.