Decision Date: 25 March 2025
Summary
In this complaint about live-in care services it was alleged that the agency provider failed to follow a suitable process when selecting a live-in carer for Mrs Y and did not complete a proper risk assessment until September 2023. This was said to lead to care worker departure and patchy cover, which was not transparently dealt with.
What happened
Mr X and Mr Y, acting on behalf of Mrs Y, raised a number of concerns about the care provided by Midshires Care Limited following Mrs Y’s hospital discharge, when she required a live-in carer. The Care Provider initially sent profiles of possible carers and arranged a call with one, Carer A, whom the family selected.
Mrs Y lived at home with her husband, Mr Y. Mr X is their son.
Carer A began in mid-July 2023, but shortly after starting, needed to attend an immigration appointment. The Care Provider had not informed the family of this before the contract was signed. Because the journey by public transport would have taken over four hours, away from the role, Mr X personally drove Carer A to that appointment.
During the placement, Carer A suggested a rotational care arrangement, which the family did not oppose. However, in early August 2023, a manager from the Care Provider made an unannounced visit to the home of Mrs and Mr Y, without prior notice or explanation. The family felt this visit contributed to Carer A’s decision to leave the placement, which she did in mid-September 2023.
The family later complained that they had not been given a proper opportunity to assess the carers’ suitability on the zoom interview that had been set up. The Care Provider told the family it could only ask prospective care staff questions about Mrs Y’s care needs, not about personal issues.
Following Carer A’s departure, the family raised formal complaints with the agency.
They were unhappy about not being told of the immigration appointment, being given an additional and incorrect direct debit mandate for the care, the unannounced visit by a manager (when they had guests at the property), and what they saw as a lack of support for Carer A, which they believe led to the failure of the placement.
In its response, the Care Provider acknowledged several errors: it should have disclosed the immigration appointment, clarified the direct debit process, and given notice of the manager’s visit to the family. It apologised for the distress caused and offered £2,414 in reimbursement for 10 days of care [for reasons unstated in the report]. It also offered to appoint a new LIC manager to improve communication.
Carer B was then assigned but remained only briefly, from 18 to 26 September 2023. The family complained about Carer B’s conduct and the poor standard of care provided. Specific concerns included running out of Mrs Y’s prescription medication, leaving Mrs Y alone to go shopping, arguing with Mr Y, not disclosing dietary requirements, making inaccurate claims about the home’s hot water supply, and leaving Mrs Y in an unsafe position. The family also said it was difficult to organise any trip involving the LIC due to the Care Provider’s expectations of their staff.
Following Carer B’s departure, the Care Provider had agreed to send carers by the hour. However, this did not happen as planned because the carer scheduled to attend was on sick leave and no replacement was available. The family considered this a failure in service provision.
Meanwhile, the Care Provider and the family remained in communication between October 2023 and January 2024 regarding outstanding payments. In January 2024, Mr X escalated the complaint to stage three, repeating earlier issues and raising additional concerns about ongoing problems with billing, the lack of clarity in invoices, and failure to provide carers as agreed.
In February 2024, the Care Provider gave its final response. It maintained that the family had been given carer profiles and opportunities to assess suitability, and again apologised for not disclosing the immigration appointment. It offered to cover Mr X’s travel expenses for the appointment. It defended the manager’s unannounced visit as a duty of care management action and said Carer B was properly trained and cleared, though acknowledged a breakdown in relations and that it had removed the carer. It said that that was because of relationship breakdown and its uncertainty about where the blame lay for conflict – ultimately, at the family’s request, not merely leaving Mrs Y without a carer. The provider noted it had already offered compensation and considered that sufficient. It also stated it was willing to address any remaining billing issues.
Mr X and Mr Y remained dissatisfied and took their complaint to the Ombudsman.
What was found
Midshires Care Limited was found at fault for failing to disclose critical information to Mr X and Mr Y, including Carer A’s immigration appointment before the placement began, which limited the family’s ability to make a fully informed decision.
The Care Provider also carried out an unannounced visit to the family home without informing them in advance, causing distress. The evidence as to why Carer A decided to leave was private but the Investigator was satisfied that it was not because of lack of support from the Care Provider.
After Carer B was assigned, the family raised serious concerns about the quality of care provided, and the relationship between Carer B and the family quickly deteriorated. The Investigator was not satisfied that the care had been poor, however. Neither was it wrong for the Care Provider to have insisted on full details about any family trip, given that it owed a duty of care to its staff.
Following this, the Care Provider failed to arrange hourly carers for Mrs Y as had been agreed, citing carer sickness but offering no alternatives. There was evidence that carer B had grown tired of treatment received from Mr Y, but this was never aired transparently, and therefore Midshires had left it unclear whether they would or would not be providing further staffing. There was evidence of a definite gap in cover, which had been distressing to the family.
Despite agreeing to place the account on hold during a billing dispute, the Care Provider continued to request payment from the family. It also issued invoices that lacked clarity, causing further confusion and frustration.
These faults caused significant injustice to Mr X, Mr Y, and Mrs Y. The family experienced avoidable distress, uncertainty, and a breakdown in trust. They were placed under emotional and practical pressure due to poor communication, inadequate care coordination, and a lack of transparency around billing and carer arrangements.
To remedy this, the investigator identified several actions for Midshires, within one month of the Ombudsman’s decision. While the Care Provider had already offered £2,414 as reimbursement after Carer A’s placement, that offer did not address the faults which occurred during or after Carer B’s involvement. Therefore, it was not considered a complete remedy.
The Investigator said Midshires should provide Mr X and Mr Y with a written apology for the identified faults and paying them £400 in recognition of the distress and uncertainty caused.
The Care Provider also agreed to review its policy for matching live-in carers with clients to ensure families have sufficient opportunity to get to know a carer before agreeing to a placement. Additionally, it committed to writing to Mr Y to clearly explain what charges were due, which accounts they related to, and how the previously offered £2,414 discount had been applied.
Points to note for councils, professionals, people using services and their carers, advocacy groups and members of the public
The LGSCO found Midshires Care Limited at fault for serious failings in the delivery and management of domiciliary care to a vulnerable adult. There was a clear breach of contract in not sending competent staff and further when not sending anyone on an hourly footing, when promised.
The investigator found that Mrs Y has several different accounts with the Care provider relating to Live IN Care and hourly rates based care. We wonder if this was something to do with the agency trying to treat the staff as self-employed, or wished to present itself as merely introducing the care worker for direct employment to the family. We can’t tell from the report what the basis of provision of the individual care staff really was.
These failures caused distress, confusion, and uncertainty for the individuals receiving care and their family members. The main fault was the provider’s inability to properly manage carer placements, ensure care quality, maintain clear financial communication, and uphold essential care standards.
The report highlights key duties that fall under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, which are designed to protect service users by setting out the fundamental standards that registered care providers must meet.
These regulations are enforced by the Care Quality Commission (CQC) and include requirements around treating people with dignity and respect, maintaining accurate records, and providing clear information about care and costs.
The following analysis explains the statutory requirements and how they were breached
By regulation 10:
‘Service users must be treated with dignity and respect… ensuring the privacy of the service user; supporting the autonomy, independence and involvement in the community of the service user.’
In this report scenario, the second live-in carer (Carer B) engaged in inappropriate behaviour, including arguing with family members and failing to meet Mrs Y’s care needs.
The absence of a robust carer matching and introductory process, combined with the Care Provider’s failure to respond promptly and effectively to concerns, resulted in Mrs Y receiving care that fell below expected standards.
This not only compromised her dignity and wellbeing but also undermined the fundamental aim of supporting her to live independently and safely in her own home.
By regulation 17(2)(c):
‘maintain securely an accurate, complete and contemporaneous record in respect of each service user, including a record of the care and treatment provided to the service user and of decisions taken in relation to the care and treatment provided’
Midshires Care Limited failed to document and communicate key information, such as confirming when live-in care had ended and providing clear updates to the family. The confusion around who was responsible for care and ongoing charges demonstrated poor governance. A lack of accurate records undermines safe, person-centred care. The failure to track and communicate critical decisions is a clear violation of Regulation 17. Care providers must have systems in place to manage care transitions and financial records.
Regulation 19 ensures that care providers employ individuals who are of good character, have the necessary qualifications, competence, skills, and experience, and are fit to carry out their roles, particularly in positions of care and responsibility.
In the case of Carer B, there were serious concerns about their conduct and care competency, including arguments with family members, mishandling of medication, failing to meet basic care tasks, and dishonesty. Given the Care Provider claimed that Carer B had all required training and checks, but also removed them after receiving complaints, there was a lack of transparency and accountability in how Regulation 19 was applied. The inconsistencies in communication and failure to address concerns promptly may reflect a failure in both recruitment procedures and post-placement oversight, contrary to the regulation’s intent.
This report illustrates how failures to meet regulatory standards under the Health and Social Care Act 2008 can cause significant harm and distress. Care providers must implement robust systems to ensure dignity in care, accurate records, and transparent financial communication. Councils and commissioning bodies should use this report as a prompt to review contracts, oversight mechanisms, and response systems for complaints and care failures.
Please use the following link if you want to read the original Local Government and Social Care Ombudsman’s Midshires Care Limited (23 019 829) report.
If you are affected by the issues in this report, please consider asking a free, one-off question, anonymously, at a level of principle, here. Our experts’ response will give you an opinion which may then help you and the broader community, when posted.
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