Louise Stickland

Updated 7 April 2023

The provider offers tongue tie services in Exeter, Plymouth, Devon and Cornwall. Tongue tie, also known as ankyloglossia, is a condition where the strip of skin connecting the babies’ tongue to the bottom of their mouth is shorter than usual or misplaced. Some babies require a surgical intervention in order to release the tongue, which is known as a frenulotomy. The provider carries out assessments of tongue function and feeding assessments prior to carrying out frenulotomy procedures.

The provider is qualified to provide frenulotomy divisions for babies up to the age of 1 year. Divisions on babies over a year are referred to the patient’s GP.

The service has been regulated with the CQC to undertake the regulated activity of surgical procedures since 5 July 2019. The provider is Mrs Louise Marguerite Stickland.

The provider is a sole trader and the clinician who provides the regulated activity. They are a registered nurse and registered with the International Board of Certified Lactation Consultants (IBCLC) for feeding and a member of the Lactation Consultants of Great Britain. They are listed as a member of the Association of Tongue Tie Practitioners (ATP).

In addition to the frenulotomy service, the provider offers baby feeding and lactation support, services which are not regulated by CQC.

Appointments are offered at the provider’s Breastfeeding Baby Studio in Exeter, or the provider will visit patients in their own homes.

There are appointments available each week on a flexible basis according to need, including home visits. These appointments are a mixture of assessments for treatment and for surgical divisions. The service undertook 421 tongue tie procedures from January 2022 to January 2023 for children between the age of 0-1 years. The service was provided for patients mainly in the southwest, but patients from other areas are welcome. Appointments can be made at short notice, 7 days a week. Face to face, telephone or email contact after appointments is ongoing as needed. Patients pay for their treatment. The premises comprise of a dedicated room in the provider’s house with a toilet for primary care givers to use.

This is the first inspection of this service since registration in 2019. We gave the provider short notice of the inspection date to ensure their availability on the day.

To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led.

The provider is registered to provide the following regulated activity:

• Surgical procedures

Louise Stickland is the Responsible Individual as a sole practitioner since registration in 2019. We inspected this service using our comprehensive inspection methodology. We carried out the short notice announced inspection on 15 February 2023.

Updated 7 April 2023

This was the first time we inspected the service. We rated it as requires improvement because it required improvement in safe, effective and well led with good in caring and responsive because;

• The provider did not always keep up-to-date with their mandatory training. The mandatory training list was not comprehensive. The provider did not control infection risk well. The service did not perform hand hygiene audits or have effective cleaning and records.
• The service did not formally ask for proper assurance of the identity of the primary care givers. Feedback was adhoc and not collected in a structured way.
• There was no process to manage patient records in the event of the provider ceasing trading.
• The provider did not run services using reliable information. The provider did not monitor the effectiveness of the service. There was no evidence of quality monitoring through regular audit. The provider did not have a risk register. Some policies were not always fit for purpose and did not contain up to date references.

However:

• The service was provided by a sole practitioner who managed appointments in order to care for patients and keep them safe. Risks to patients were assessed, acted on and good care records were kept. The service managed safety incidents well and learned lessons from them.
• The provider was competent. The provider worked for the benefit of patients, advised primary care givers about feeding and how to breast feed if there were issues and had access to good information. Key services were available seven days a week.
• The provider treated patients and primary care givers with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to primary care givers.
• People could access the service when they needed it and did not have to wait too long for treatment.

Updated 7 April 2023

We had not rated this service before. We rated it as requires improvement because:

• The provider did not always keep up-to-date with their mandatory training. The mandatory training list was not comprehensive.
• The provider did not control infection risk well. The service did not perform hand hygiene audits or have effective cleaning and records.
• The service did not formally ask for proper assurance of the identity of the primary care givers. Feedback was adhoc and not collected in a structured way.
• There was no process to manage patient records in the event of the provider ceasing trading. The provider could not always meet the individual needs of patients and primary care givers.
• The provider did not run services using reliable information. The provider did not monitor the effectiveness of the service.
• There was no evidence of quality monitoring through regular audit although the provider had made some improvements. Some policies were not always fit for purpose and did not contain up to date references.
• The provider did not keep a risk register.

However:

• The service was provided by a sole practitioner who managed appointments in order to care for patients and keep them safe.
• Risks to patients were assessed, acted on and good care records were kept. The service managed safety incidents well and learned lessons from them.
• The provider was competent. The provider worked for the benefit of patients, advised primary care givers about feeding and how to breast feed if there were issues and had access to good information.
• Key services were available seven days a week.
• The provider treated patients and primary care givers with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to primary care givers.
• People could access the service when they needed it and did not have to wait too long for treatment.
• The provider had a vision for the service and applied in their work. They were focused on the needs of patients receiving care.
• The service engaged well with patients to plan and manage services.