Tonguetie Jackie

Updated 18 August 2022

Some babies are born with the condition tongue-tie, which has the medical name ankyloglossia. The fold of skin under the tongue that connects to the tongue to the bottom of the mouth is shorter than usual, which restricts the movement of the tongue. This can cause problems with feeding and the baby may not gain weight at the normal rate.

Some babies require a surgical intervention in order to release the tongue, which is known as a Frenulotomy or frenotomy. Frenulotomy services may be offered by the NHS or independent healthcare professionals such as doctors, dentists, or midwives, nurses or chiropractors.

The provider is a registered midwife who offers private tongue-tie services to the community in London and the surrounding counties. The provider is qualified to provide Frenulotomy divisions for babies up to the age of one year. The procedure is normally done on babies aged from new-born to six months old. Divisions on older babies with teeth are referred to the local NHS team or to the patient’s GP.

The registered manager is a sole trader who provides the regulated activity. This will be their first CQC inspection since registration in 2019.

The service is registered with the CQC to provide the following regulated activity:

• Surgical procedure

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

Updated 18 August 2022

This is the first time we rated this location. We rated it as good because:

• Mandatory training was up to date. The service followed good practice with respect to safeguarding. The service-controlled infection risks well, including COVID 19 transmission and protection. All surgical instruments were single use devices and clinical waste was disposed of safely. The service involved the family to prepare equipment for the procedure prior to the appointment. Personalised risk assessments were carried out before every home visit on the telephone. Well known assessment tools were used to assess the mobility of the baby’s tongue. Patient records were stored securely and completed accurately with detail. The provider had not needed to report any incidents in the last 12 months but was equipped with the knowledge of how to do this.
• The service adapted policies from the Association of Tongue Tie Professionals (ATP) and personalised them for their own practice. Full feeding assessments were carried out in line with best practice. Primary care givers were given support and encouragement to feed their baby well. The service engaged in clinical audit to evaluate and quality of care they provided. The registered manager was competent in their role and could draw on their work as a registered midwife for additional skills and knowledge. Appointment times were flexible to suit the needs of the service user. The service ensured that the consent process was understood and completed before procedures were carried out.
• The service treated service users with compassion and kindness, respected their home and understood their individual needs. They involved primary care givers and family members in the baby’s care decisions. Parents spoke highly of the service provided and of the registered manager. The registered manager created an inclusive conversation around the baby’s care, which included other children that were present in the household.
• Appointment times were flexible to meet the needs of the family. Families could access the provider quickly and easily and use a messenger application that was convenient for the family.
• The registered manager had appropriate skills and knowledge to run the service and continued to learn new information to help their clients.

However:

• The service did not have information leaflets in alternative languages spoken by the families living in the local community. The provider discussed introducing client payable translation services soon.
• The service did not make it easy for service users to give feedback where they had a complaint.
• The registered manager did not have a vision for the service; however, this was being implemented and added to the services website.

Updated 18 August 2022

This is the first time we inspected this service. We rated it as good because:

• The registered manager had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risks well. The registered manager assessed risks to patients, acted on them and kept good care records. The service had a system in place to investigate and share any learning, if such a situation arose.
• The registered manager provided good standards of care and treatment and gave advice to families on how to feed their baby. The registered manager monitored the effectiveness of the service. They advised families on how to lead healthier lives, supported them to make decisions about their baby’s care, and had access to a range of information. Key services were available five days a week.
• The registered manager 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 baby’s condition. They provided emotional support to families, and carers.
• The service planned care to meet the needs of local people, took account of families’ individual needs. People could access the service when they needed it and did not have to wait too long for an appointment.
• Registered managers ran services well using reliable information systems. They were focused on the needs of patient receiving care. The service engaged well with patients and their family. They were committed to improving the service continually.

However:

• The service did not have information leaflets in alternative languages spoken by the families living in the local community. The provider discussed introducing translation services soon.
• The service did not make it easy for service users to give feedback where they had a complaint.
• The registered manager did not have a vision for the service; however, this was being implemented and added to the services website.