What Makes a CQC Outstanding Tongue-Tie Service?

Tongue-tie Service - CQC OUTSTANDING

When you are looking for help with your baby's feeding, you are not simply choosing somewhere to have a tongue-tie assessed or a procedure carried out.

You are choosing someone to care for your baby at a time when you may already be tired, worried, in pain or unsure what to do next.

You may be wondering:

• Is my baby safe?

• Does this person really understand infant feeding?

• Will someone listen to our whole story, rather than simply look inside my baby's mouth?

• What happens if we need help afterwards?

• What qualifications, experience and regulation sit behind the service?

• If we decide against a procedure, will we still be supported?

These questions matter.

For me, they are at the heart of how I have developed D-Restricted Ltd®.

My vision for D-Restricted Ltd®

My vision for D-Restricted Ltd® is:

> At D-Restricted Ltd, my vision is to provide highly skilled, compassionate, and evidence-informed support in infant feeding, ensuring every feeding dyad can feed comfortably and confidently within a nurturing family or wider network. I am committed to maintaining up-to-date clinical expertise and delivering care grounded in best practice, with tongue-tie and infant feeding care close to my heart. Central to my approach is personalised aftercare and ongoing guidance, recognising that feeding challenges do not end at the consultation. Through attentive intervention, education, and compassionate support, I aim to strengthen the feeding relationship, empower families, and foster reassurance and confidence throughout the feeding journey, always prioritising the infant’s wellbeing and the needs of their supportive network.

This is not simply a statement on a website.

During its inspection of D-Restricted Ltd®, the Care Quality Commission (CQC) assessed whether the service's leadership, culture, clinical care, systems and approach to families reflected this vision.

In June 2026, D-Restricted Ltd® received an Overall Outstanding rating from the Care Quality Commission at its first inspection.

Read the CQC press release: CQC rates specialty tongue-tie service Outstanding at first inspection

Read the full CQC inspection report

Experience behind the service

D-Restricted Ltd® was founded in 2014, but my experience of caring for people and supporting families began much earlier.

I began working with families as a healthcare worker in 1998 before starting my nurse training in 2002. I qualified as a Registered Nurse in 2005 and initially worked in neurosurgery, developing my clinical assessment, observation and care-planning skills.

My own experience of having children with tongue-tie then led me to develop a particular interest in infant feeding and tongue-tie.

I moved into neonatal nursing, where I worked with newborn babies and their families and developed specialist knowledge and experience in neonatal care. I qualified in neonatal nursing and continued to develop my understanding of infant feeding, including becoming a tongue-tie specialist in 2014 and founding D-Restricted Ltd®.

My specialist infant-feeding journey continued to develop through further education and experience. I became an LEAARC Infant Feeding Specialist in 2017 and an International Board Certified Lactation Consultant (IBCLC) in 2018. Before this, I had also undertaken training as an ABM breastfeeding peer supporter and counsellor.

Each stage of my career has added something different to the way I work today.

My nursing background provides a strong foundation in clinical assessment, safety and recognising when a baby or caregiver may need additional medical support. My neonatal experience has given me many years of caring for newborn babies and their families. My infant-feeding education and IBCLC qualification have developed my understanding of breastfeeding and infant feeding, while my specialist tongue-tie experience has allowed me to develop a deeper understanding of how oral function can interact with feeding.

Most importantly, supporting families over many years has taught me that there is rarely a single answer to a feeding problem.

A baby is not simply a tongue, a frenulum, a feeding position or a weight.

There is a baby, a caregiver, a feeding relationship and a wider family or support network around them.

That understanding is central to the way D-Restricted Ltd® operates today.

The service has therefore developed from years of clinical experience, specialist education and listening to families, rather than being built around a single procedure.

It is this experience that has shaped my emphasis on whole-dyad assessment, family-centred care, informed choice and, importantly, personalised aftercare and ongoing support.

The CQC Outstanding rating is recognition of the service as it operates today, but the experience behind that service has been built over many years.

What does an Overall Outstanding CQC rating mean?

The CQC regulates health and social care services in England and assesses services using five key questions:

• Is it safe?

• Is it effective?

• Is it caring?

• Is it responsive to people's needs?

• Is it well-led?

These five areas are important because good healthcare is about much more than what happens during a single appointment.

An Overall Outstanding rating is the highest overall rating that CQC awards.

The significance of this is that the rating is not based simply on one procedure, one appointment or one family's experience. It reflects the CQC's assessment of the service as a whole.

What does this mean for your baby's care?

For a family, regulation can sometimes feel like a world of paperwork and terminology.

So what does it actually mean when you are choosing a tongue-tie service?

It means there should be systems behind the care you receive.

There should be appropriate clinical governance, risk management, infection prevention and control, safeguarding arrangements, record keeping, consent processes, professional development and processes for responding when something does not go as expected.

It also means that the person providing regulated care needs to have the appropriate professional knowledge, skills and experience for the care they provide.

Tongue-tie care is a regulated healthcare service

In England, certain healthcare activities are regulated by the CQC under the Health and Social Care Act 2008 and associated regulations.

Where a provider is carrying out a regulated activity that requires CQC registration, the provider must be registered with the CQC.

D-Restricted Ltd® is registered with the CQC for the regulated activity of Surgical procedures.

This is an important distinction for families.

A person offering information about tongue-tie, feeding support or a non-regulated service is not necessarily providing the same type of regulated healthcare service as a CQC-registered provider undertaking a surgical procedure.

CQC registration does not mean that a procedure is right for every baby. It means that the service providing the regulated activity is subject to a specific regulatory framework and inspection process.

The people providing care must be appropriately registered

Where a provider employs people to carry out regulated activities, the provider must have appropriate systems to ensure that staff have the necessary qualifications, competence, skills and experience for their roles.

For a CQC-registered provider, the provider's Statement of Purpose identifies the regulated activities and the people responsible for delivering them.

For families, this provides another important layer of transparency about who is providing their care and under what regulatory framework.

The person providing your baby's care matters too

D-Restricted Ltd® is a specialist independent service led and delivered by me.

My professional background includes nursing, neonatal nursing experience, International Board Certified Lactation Consultant (IBCLC) qualification and specialist experience in infant feeding and tongue-tie care.

I have continued to develop my clinical knowledge and skills throughout my career because caring for babies and feeding families requires more than completing one course and stopping there.

My approach is evidence-informed and function-focused.

Anatomy provides information. Function provides context.

A visible or restricted lingual frenulum is one part of an assessment. It should not automatically become the explanation for every feeding difficulty.

Feeding can be affected by many factors, and sometimes there is more than one contributing factor.

This is why I take time to understand the individual baby's feeding, the caregiver's experience, the feeding history, the infant's function and the family's goals.

Family-centred care means listening to you

CQC rated D-Restricted Ltd® Outstanding for Caring.

This is particularly meaningful to me because family-centred care is central to the way I work.

You are not simply bringing your baby to have something "fixed".

You are bringing your own experience.

You may have been struggling with painful breastfeeding.

You may be worried about your baby's weight gain.

You may be experiencing difficulties with bottle feeding.

You may have been given conflicting advice.

You may have already tried different approaches.

Or you may simply have a feeling that feeding isn't going as you expected.

Your experience matters.

Family-centred care means listening to what you are experiencing, understanding what matters to you, explaining what I am seeing and giving you the information you need to make an informed decision.

It means discussing options rather than assuming there is only one.

And it means respecting your decision.

Whether you choose breastfeeding, bottle feeding, combination feeding, expressed milk, conservative management, further assessment or a procedure, you should be treated with the same respect and support.

An assessment is not simply looking at a frenulum

A tongue-tie assessment should consider more than what a baby's tongue looks like.

The assessment needs to consider function and the impact that any restriction may be having on feeding.

This may include discussing feeding history, observing feeding where appropriate, considering the baby's oral function and looking at the wider circumstances surrounding feeding.

There may be other reasons for a feeding difficulty.

There may be several factors contributing at the same time.

This is why an assessment should not begin with the assumption that a frenulum is automatically the cause of the problem.

The aim is to understand your baby and your feeding journey.

Outstanding care does not mean every baby needs a procedure

An Overall Outstanding CQC rating does not mean that every baby seen by D-Restricted Ltd® has a tongue-tie that needs dividing.

Nor does it mean that a frenulotomy will resolve every feeding difficulty.

Evidence surrounding tongue-tie and frenotomy has limitations, and good care requires honest conversations about what is known, what is uncertain and what other factors may be involved.

The Cochrane review of frenotomy in newborn infants found that frenotomy reduced maternal nipple pain in the short term, but evidence for improvements in infant breastfeeding was inconsistent and based on small studies with methodological limitations (O'Shea et al., 2017).

The Academy of Breastfeeding Medicine similarly emphasises the importance of a skilled breastfeeding assessment and functional assessment when considering ankyloglossia (Academy of Breastfeeding Medicine, 2021).

This means families deserve an individualised discussion rather than a promise of a particular outcome.

Sometimes feeding support is the appropriate next step.

Sometimes further assessment is needed.

Sometimes a procedure may be considered.

Sometimes another healthcare professional needs to be involved.

Outstanding care leaves room for all of those possibilities.

Informed consent is more than signing a form

If a procedure is being considered, informed consent should be a conversation.

You should have the opportunity to understand what has been identified, why a procedure may or may not be considered, what alternatives exist, what the potential benefits and risks are, and what support is available afterwards.

You should have time to ask questions.

You should not feel pressured into making a decision.

And choosing not to proceed with a procedure should not mean that you are no longer supported.

Why aftercare matters so much

This is one of the most important differences in the way I have developed D-Restricted Ltd®.

Feeding challenges do not necessarily end when the appointment ends.

A procedure may change tongue movement, but a baby's feeding experience does not automatically change overnight.

A baby may need time to adapt.

A caregiver may need support with positioning or attachment.

Breastfeeding families may need help protecting milk supply or adjusting feeding techniques.

Bottle-feeding families may need help understanding changes in feeding behaviour, pace, comfort or coordination.

Some babies may need further assessment or support from another professional.

And sometimes families simply need someone to talk to when they are unsure whether what they are seeing is expected.

This is why personalised aftercare and ongoing guidance are central to my service.

CQC rated D-Restricted Ltd® Outstanding for Responsive care.

The CQC specifically recognised the service's approach to continuity of care, including the six-week tongue-tie package incorporating feeding reviews, tongue-function checks and emotional wellbeing support, as well as the wider support available to families.

The service also provides an online Support Portal and access to ongoing support.

For me, this is what family-centred care looks like in practice.

You shouldn't have to leave a clinic with your baby and then work everything out for yourself.

CQC didn't simply take my word for it

A CQC rating is not something a provider awards themselves.

Before receiving its rating, D-Restricted Ltd® underwent a detailed CQC inspection.

Inspectors reviewed evidence about how the service operated and examined the systems and processes supporting the care provided.

This included reviewing records, policies, governance arrangements, clinical processes, risk management and evidence of how the service monitored and improved the quality of care.

Inspectors also spoke to people who had used the service and considered their experiences.

The inspection took place over three days and involved inspectors examining evidence and observing how the service operated in practice.

This matters because there is a significant difference between saying:

"I provide excellent family-centred care."

and having an independent regulator examine the systems, evidence, clinical practice and experiences of families and conclude that the service meets the CQC's standards for an Overall Outstanding rating.

Families' experiences matter

Patient and caregiver feedback is an important part of understanding whether a healthcare service is delivering the care it aims to provide.

During the inspection, CQC considered feedback from people who had used D-Restricted Ltd®.

CQC reported that the service had received positive feedback from families and that caregivers interviewed during the inspection spoke highly of the care they had received and said they would recommend the service.

For me, this is not simply about collecting five-star reviews.

It is about listening.

If families tell me that they felt heard, supported and reassured, that helps demonstrate whether the values behind the service are reaching the people they are intended to help.

If someone raises a concern, that matters too.

Good governance means being willing to listen, learn and improve.

Outstanding Well-led: building the systems behind a specialist service

D-Restricted Ltd® is a specialist independent service led and delivered by one person.

That does not mean that the governance behind the service can be small.

As a sole practitioner, I am responsible for the clinical care and for the systems that support it.

That includes leadership, governance, policies, risk management, professional development, quality improvement, record keeping, safeguarding, infection prevention and control, feedback and ongoing review of the service.

There isn't a large organisation behind me providing separate departments for these things.

I have had to build and maintain those systems myself.

CQC rated D-Restricted Ltd® Outstanding for Well-led.

The inspection considered the leadership, culture, governance, learning, innovation and commitment to continuous improvement within the service.

This is also why education is an important part of what I do.

Through Tongue-tie School®, I provide professional education designed to help healthcare professionals and practitioners develop their understanding of tongue-tie awareness, assessment considerations, treatment considerations and wrap-around care.

Sharing knowledge and encouraging good practice is part of my commitment to improving the wider care available to families.

What does an Outstanding service look like to me?

For me, Outstanding care is not about claiming to have all the answers.

It is about combining clinical knowledge with compassion.

It is about listening before making assumptions.

It is about recognising that a baby is part of a feeding dyad and a wider family or support network.

It is about understanding that feeding difficulties may have more than one cause.

It is about giving families honest information rather than promises.

It is about respecting their choices.

It is about knowing when to provide support, when to review, when to refer and when to say that a procedure is not the right answer.

And it is about remaining available to support the family after the consultation.

Why the CQC Outstanding rating matters

There are many people providing information, support and services around tongue-tie and infant feeding.

For families, it can be difficult to know what level of training, experience, regulation, governance and aftercare sits behind any particular service.

A CQC rating cannot tell you whether a particular treatment is right for your baby.

It cannot guarantee a particular feeding outcome.

But an Overall Outstanding CQC rating does provide independent regulatory recognition of how the service itself is run and delivered.

D-Restricted Ltd® received an Overall Outstanding rating at its first CQC inspection, with Outstanding ratings for Caring, Responsive and Well-led.

That recognition matters to me because it reflects the things I have worked hard to build into the service:

• specialist clinical experience

• evidence-informed infant feeding care

• appropriate regulation and governance

• family-centred decision-making

• personalised aftercare

• continuity of support

• ongoing professional education

• listening to families

• learning from feedback

• a commitment to continually improve

My vision is to help every feeding dyad feed comfortably and confidently within a nurturing family or wider network.

And my guiding principle remains:

> Every feeding journey deserves support, compassion and reassurance.

For families trusting me with their baby, that is what the Outstanding rating is really about.

References

Academy of Breastfeeding Medicine (2021) ‘Academy of Breastfeeding Medicine position statement on ankyloglossia in breastfeeding dyads’, Breastfeeding Medicine, 16(4), pp. 278–281. Available at: https://doi.org/10.1089/bfm.2021.29179.ams (Accessed: 24 August 2026).

Care Quality Commission (2026a) D-Restricted Ltd: Surgical procedures. CQC inspection report. Available at: https://www.cqc.org.uk/location/1-13757340686/reports/LAP-02504/surgery (Accessed: 24 August 2026).

Care Quality Commission (2026b) CQC rates specialty tongue-tie service Outstanding at first inspection. CQC press release. Available at: https://www.cqc.org.uk/press-release/cqc-rates-specialty-tongue-tie-service-outstanding-first-inspection (Accessed: 24 August 2026).

Care Quality Commission (2026c) D-Restricted Ltd: Caring. CQC inspection report. Available at: https://www.cqc.org.uk/location/1-13757340686/reports/LAP-02504/surgery/caring (Accessed: 24 August 2026).

Care Quality Commission (2026d) D-Restricted Ltd: Responsive. CQC inspection report. Available at: https://www.cqc.org.uk/location/1-13757340686/reports/LAP-02504/surgery/responsive (Accessed: 24 August 2026).

Care Quality Commission (2026e) D-Restricted Ltd: Well-led. CQC inspection report. Available at: https://www.cqc.org.uk/location/1-13757340686/reports/LAP-02504/surgery/well-led (Accessed: 24 August 2026).

National Institute for Health and Care Excellence (2005) Division of ankyloglossia (tongue-tie) for breastfeeding: Interventional procedures guidance [IPG149]. London: NICE. Available at: https://www.nice.org.uk/guidance/ipg149 (Accessed: 24 August 2026).

Nursing and Midwifery Council (2018) The Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates. London: NMC. Available at: https://www.nmc.org.uk/standards/code/ (Accessed: 24 August 2026).

O'Shea, J.E., Foster, J.P., O'Donnell, C.P.F., Breathnach, D., Jacobs, S.E., Todd, D.A. and Davis, P.G. (2017) ‘Frenotomy for tongue-tie in newborn infants’, Cochrane Database of Systematic Reviews, 3, CD011065. Available at: https://doi.org/10.1002/14651858.CD011065.pub2 (Accessed: 24 August 2026).

UK Government (2008) Health and Social Care Act 2008. Available at: https://www.legislation.gov.uk/ukpga/2008/14/contents (Accessed: 24 August 2026).

UK Government (2014) Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. SI 2014/2936. Available at: https://www.legislation.gov.uk/uksi/2014/2936/contents (Accessed: 24 August 2026).