Summary: Ms X complained the Care Provider failed to provide adequate care to her mother, Mrs Y, and did not clearly explain its charging structure before care started. She said this caused avoidable uncertainty and frustration, as well as financial loss. We found no fault with the Care Provider’s actions. The Care Provider had already offered a satisfactory remedy for fault identified in the early complaints process.

The complaint

1. Ms X complained Midshires Care Limited (the Care Provider) failed to provide adequate care to her mother, Mrs Y. She also said the Care Provider did not clearly explain its charging structure before care started. Ms X said this caused avoidable uncertainty and frustration, as well as financial loss.

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The Ombudsman’s role and powers

2. We investigate complaints about adult social care providers and decide whether their actions have caused an injustice, or could have caused injustice, to the person making the complaint. I have used the term fault to describe such actions. (Local Government Act 1974, sections 34 B, 34C and 34 H(3 and 4) as amended)
3. Part 3 and Part 3A of the Local Government Act 1974 give us our powers to investigate adult social care complaints. Part 3A is for complaints about care bought directly from a care provider by the person who needs it, or their representative, and includes care funded privately or with direct payments using a personal budget. (Part 3 and Part 3A Local Government Act 1974; section 25(6) & (7) of the Act)
4. We may investigate complaints from the person affected by the complaint issues, or from someone else if they have given their consent. If the person affected cannot give their consent, we may investigate a complaint from a person we decide is a suitable representative. (section 26A or 34C, Local Government Act 1974)
5. If we are satisfied with an organisation’s actions or proposed actions, we can complete our investigation and issue a decision statement. (Local Government Act 1974, section 30(1B) and 34H(1), as amended)

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How I considered this complaint

6. I considered evidence provided by Ms X and the Care Provider as well as relevant law, policy and guidance.
7. Ms X and the Care Provider had an opportunity to comment on my draft decision. I considered any comments before making a final decision.

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What I found

ASC provider

8. We can investigate complaints about actions by adult social care providers that can be regulated by the Care Quality Commission. Such activities include giving personal care or other practical support in the place where the person lives.
9. The law defines ‘personal care and other practical support’ as ‘physical assistance (or prompting and assistance) given to a person in connection with:

• eating or drinking (including giving nutrition other than by mouth or alimentary canal);
• toileting (including in relation to menstruation);
• washing or bathing;
• dressing;
• oral care; or
• the care of skin, hair and nails (except for nail care provided by a chiropodist or podiatrist)’.
  (Health and Social Care Act 2008 (Regulated Activities) Regulations 2010)

Fundamental Standards of Care

10. The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 set out the fundamental standards that registered care providers must achieve. The Care Quality Commission (CQC) has guidance on how to meet the fundamental standards.

Charging

11. The Care Quality Commission (CQC) expects care providers to give people clear information about the fees they will be charged and any additional costs before care starts. People should be able to understand what services they are buying, what those services will cost, and any terms attached to those charges. In considering complaints about care fees, we would normally expect a provider to have given clear written information about its pricing and charges before entering into an agreement to provide care.

What happened

12. Ms X contacted the Care Provider in early August 2025 to arrange care at home for her mother, Mrs Y. Before the service started, the Care Provider sent Ms X an email containing links to its terms and conditions and pricing structure documents. It also completed a care needs assessment and agreed a care plan for Mrs Y.
13. The Care Provider began providing two daily 30-minute care visits from mid-August 2025. In September 2025, Ms X raised concerns about the service. She said carers did not always stay for the full duration of visits or complete all tasks in Mrs Y's care plan. She also reported difficulties accessing the Care Provider’s online portal and contacting staff, and asked for the contact details of the carers visiting Mrs Y so she could discuss care issues with them. Ms X also complained that invoices were being sent to Mrs Y rather than to her as the financial representative.
14. Ms X also queried the charges for the care package. In particular, she questioned how the Care Provider calculated charges for 30-minute visits compared with its hourly rates. The Care Provider explained its charging structure and provided copies of invoices.
15. Ms X later made a formal complaint. She said the Care Provider had not clearly explained its charging arrangements before care commenced. She repeated her concerns about the quality of care, communication issues and visit lengths. The Care Provider escalated the complaint to stage two of its complaints process.
16. While the complaint investigation was ongoing, Ms X arranged an alternative care provider for Mrs Y. The Care Provider continued providing care until the new arrangements were in place and the service ended in October 2025.
17. As part of its complaint investigation, the Care Provider identified an incident in which a carer failed to administer Mrs Y's inhaler. It investigated the matter, made a safeguarding referral and considered the actions of the staff member involved.
18. In its stage two complaint response, issued in October 2025, the Care Provider upheld Ms X's complaints regarding the missed inhaler administration and difficulties accessing the online portal. It apologised for these issues. However, it did not uphold the remaining complaints, including those relating to charging, visit lengths and the completion of care tasks. It explained that some tasks were not completed because Mrs Y chose to decline support, and that it could not share individual staff members' contact details.
19. Ms X remained dissatisfied and requested a further review. In November 2025, the Care Provider issued its stage three response. It maintained its previous findings, apologised for the identified failings and offered Ms X £250 in recognition of the frustration caused.

Analysis

20. Ms X said the Care Provider did not clearly explain its charges and that, had she understood the true cost of the package, she would not have agreed to it. However, the evidence showed the Care Provider sent Ms X written information before care started, including its terms and conditions and a pricing document. These clearly set out the charges for one-hour, 45‑minute and 30‑minute visits, the different rates for weekday and weekend visits, as well as bank holidays, and the applicable travel charge for each visit. The invoices issued were consistent with the published pricing structure.
21. I am satisfied the Care Provider gave Ms X sufficient information about its charges before the service began and applied those charges in line with its published rates. Therefore, I find no fault in the way it explained or applied its charging arrangements.
22. Ms X experienced difficulties accessing the Care Provider’s online portal, and invoices were initially sent to Mrs Y rather than Ms X. The Care Provider accepted there were issues with portal access and the invoicing address, and took steps to address them. While these issues were frustrating for Ms X, I have seen no evidence they caused Ms X or Mrs Y a significant injustice.
23. In relation to the quality of care provided, Ms X said carers did not always complete the agreed tasks or remain for the full scheduled visit. The records provided by the Care Provider indicate that on some occasions Mrs Y declined support or had already completed certain tasks before carers arrived. There is no evidence demonstrating a pattern of missed care, shortened visits, or failure to provide the agreed service. Therefore, I find no fault with the Care Provider on this point.
24. The evidence does show one occasion when a carer failed to administer Mrs Y's inhaler. The Care Provider identified this failure itself, investigated the matter, made a safeguarding referral and took action regarding the staff member concerned. There is no evidence of repeated medication errors or wider concerns about medication management. In the circumstances, I consider the Care Provider's response to this incident was appropriate.
25. While I have not found fault in most aspects of the service complained about, the evidence shows there was a failure to administer Mrs Y's inhaler on one occasion and difficulties accessing the online portal. These faults caused avoidable frustration and uncertainty. The Care Provider identified the issues, apologised, investigated appropriately and offered £250. I consider this to be a suitable remedy for the injustice caused.

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Investigator's decision on behalf of the Ombudsman