Plus Point Care Limited v Care Quality Commission

By notice dated 26 February 2026 the Appellant appeals against the Respondent’s decision dated 6 February 2026 to suspend its registration as a service provider in respect of the regulated activity of personal care and treatment of disease, disorder or injury. The regulated activities are delivered by way of domiciliary care provided to service users in their homes.

The right of appeal lies under section 32 of the Health and Social Care Act 2008 (the Act).

The Appellant company was first registered to provide the regulated activities with the Respondent in November 2021. Mrs Schuhmacher is the director of the limited company. In terms of registration, she is also the nominated individual (the NI) and the registered manager (the RM). The registered location is an address in Nottingham from which the overall service is provided/directed.

The Respondent is the statutory body responsible for the registration of those who seek to provide regulated activities i.e. activities connected with the provision of health or social care. The main statutory objective of the Commission in performing its review and investigative functions is to protect and promote the health, safety and welfare of people who use health and social care services.

On 11 March 2026 in the exercise of case management powers Judge Khan made a restricted reporting order (RRO) under Rule 14(1) (a) and (b) of the 2008 Rules, prohibiting the disclosure or publication of any documents or matter likely to lead members of the public to identify the service users in this case so as to protect their private lives. That order continues.

We extended the order at the hearing so as to protect the private life interests of the director/nominated individual and her family members in relation to confidential health matters. We decided that in the circumstances it would be ineffective to simply anonymise the name of the director since this could be ascertained in public/company records. We decided that the appropriate course was to provide a separate document regarding the detail of relevant/confidential health matters, which document is subject to a restricted reporting order.

This appears to be as follows:

she had instructed one of her staff, MM, to conduct a “safety pause” for all current service users that day, reporting any changes in health, skin integrity or mobility directly to the office. She said that “we will provide a full audited summary of these needs and updated care plans for any high-risk individuals by Monday (9 February).

She had instructed her administrative assistant (KM) to reconcile the training matrix. Verified training certificates would be uploaded by Friday. In the interim no staff member will be permitted to perform tasks, including medicines administration, unless their verified certificate is on file.

KM is the point of contact for all documentation requests and on-site clinical escalations are being managed by care staff.

This is a matter of record, but we summarise the main reasons given:

Governance: The information obtained from Plus Point Care Ltd and following discussion with SM 1 and SM 2 gave no assurance that interim leadership was able to provide safe care to service users. The registered manager was unable to engage with the Commission’s assessment due to ill health, and the delegated alternative staff were not aware of this responsibility or not trained to complete this oversight. Staff Member 2 (KM) was not at work on 5 February 2026, they had not completed their induction, and they were not aware of the length of time the registered manager would not be available. They had not been given the task reported by Mrs Schuhmacher to complete the review of staff training. SM 1 was not aware the registered manager was off work unwell, or the expectation, shared with the Commission by the registered manager, that SM 1 would be part of the delegated team to maintain service safety and oversight. Additionally, the registered manager informed the Commission that to be able to ensure service users were safe and fed, SM 1 needed to be delivering front line care calls.

Medicine Administration: Issues were raised on 19 January 2026 regarding the administration of medicines by staff who were not trained or competent. SM 3 had worked outside of their competence. Mrs Schuhmacher said on 19 January 2026 that SM 3 was still shadowing and was not providing care by themselves, but the rota showed that SM 3 was working independently to support service users who require medicines assistance. Mrs Schuhmacher said that SM 3’s competency would be reassessed before SM 3 provided medicine support to service users. However, the rota showed that SM 3 was rostered to work before the planned assessment.

Health condition management: The Commission identified service users who were at risk of harm from deterioration in their physical health because care documentation had not addressed risk.

Safeguarding: The staff training record provided on 26 January 2026 showed safeguarding adults training had not been completed by 4 of the 9 staff the Commission were told were currently working. This included staff who were working independently, such as SM 3. The LOI sent by email on 4 February 2026 outlined concerns about staff not having adequate training in safeguarding. This response from the registered manager did not explicitly mention the risk of a lack of safeguarding training. The Commission were told an updated training record would be produced and sent, and staff would only be able to work within their assessed competency. There was no administrator available on 5 February 2026 to complete a timely review of staff records to ensure staff were sufficiently trained in safeguarding to ensure service user safety. SM 2 had not been informed they were expected to do this by the registered manager. Therefore, no staff member attempted to identify and rectify missing training, and staff would continue to support service users regardless of training or lack of. This risk has not been adequately addressed or mitigated.

Infection prevention and control:

The Appellant seeks an order setting aside the decision made. The Appellant relies on eight points/grounds which largely relate a chronology of events. The main points are that the Appellant considers that the decision was procedurally unfair and disproportionate. The CQC had bypassed Mrs Schuhmacher whilst she was signed off sick and had spoken to staff. The CQC did not allow the delegated structure to function before intervening. Suspension is the most extreme sanction. Despite her cooperation and the interim safety measures, the CQC did not consider lesser options such as conditions or a warning

We noted also that Mrs Schuhmacher wrote to the Respondent on 6 Feb at 21.32. Amongst other matters she considered (and still considers) that the decision to suspend was based on a state of confusion that was directly induced by the Respondent’s own uncoordinated and conflicting instructions. Despite the 12 pm deadline Ms Lenton had bypassed this and had contacted MM (SM 2) at 11.41 am on 5 February whilst she (MM) was delivering front line care. Mrs Schuhmacher’s position is that this was active disruption of her delegated management which occurred before she had the opportunity to complete the emergency handover. She complained that to use the responses of a new trainee (KM) under pressure and before the 12 pm deadline for the training matrix had passed did not provide a fair representation of the Appellant’s governance.

The relevant parts of the Act are as follows:

The main objective of the Commission in performing its functions is to protect and promote the health, safety and welfare of people who use health and social care services.

The Commission is to perform its functions for the general purpose of encouraging—

the improvement of health and social care services,

the provision of health and social care services in a way that focuses on the needs and experiences of people who use those services, and

the efficient and effective use of resources in the provision of health and social care services.

views expressed by or on behalf of members of the public about health and social care services,

views expressed by Local Healthwatch organisations or Local Healthwatch contractors about the provision of health and social care services,

The need to protect and promote the rights of people who use health and social care services (including, in particular, the rights of children, of persons detained under the Mental Health Act 1983, of persons who are deprived of their liberty in accordance with the Mental Capacity Act 2005 (c. 9), and of other vulnerable adults),

the need to ensure that action by the Commission in relation to health and social care services is proportionate to the risks against which it would afford safeguards and is targeted only where it is needed.

If the Commission has reasonable cause to believe that unless it acts under this section any person will or may be exposed to the risk of harm, the Commission may, by giving notice in writing under this section to a person registered as a service provider or manager in respect of a regulated activity, provide for any decision of the Commission that is mentioned in subsection (2) to take effect from the time when the notice is given.

a decision under section 18 to suspend the registration or extend a period of suspension.

An appeal against—

any decision of the Commission under this Chapter, other than a decision to give a warning notice under section 29 [or 29A],….

On an appeal against a decision to which a notice under section 31 relates, the First-tier Tribunal may confirm the decision or direct that it is to cease to have effect.

On an appeal against a decision or order, the First-tier Tribunal also has power—

to vary any discretionary condition for the time being in force in respect of the regulated activity to which the appeal relates,

to direct that any such discretionary condition is to cease to have effect,

to direct that any such discretionary condition as the First-tier Tribunal thinks fit shall have effect in respect of the regulated activity….

Mrs Schuhmacher said she represented the Appellant company. Her full name is recorded above. She said she could be referred to as Mrs Schuhmacher.

The panel was mindful of the difficulties potentially faced by Mrs Schuhmacher regarding her own health. The judge asked whether she wished the panel to make any reasonable adjustments. She said that she appreciated the panel’s concern, but no adjustments were necessary.

We had before us an indexed electronic bundle consisting of 585 pages pdf. Mrs Schuhmacher confirmed that she had access to the same bundle. We need not describe the bundle in detail. It is fully indexed. Amongst other matters, it includes the parties’ respective positions regarding the alleged breaches as set out in the Scott Schedule. We were also assisted by the skeleton argument provided by the Respondent.

During the hearing it was agreed between the parties that we should also receive additional evidence: an email from Mrs Schuhmacher sent to the Respondent at 08.59 on Monday 9 February 2026 and the response sent to the Appellant at 09.33 that day. The parties agreed that the evidence was relevant and it was fair that we should receive it. We noted that the Appellant’s email at 08.59 was in fact already in the bundle. It is the Respondent’s reply that was additional.

There were no significant difficulties with the video connection during the hearing.

At the start of the hearing the judge explained the legal framework to the parties and, in particular, that the Tribunal is not concerned with fact-finding, but with the assessment of risk in the context of the nature, substance and cogency of the concerns raised and, if the threshold test is met, the assessment of necessity, justification and proportionality.

The Tribunal is required to determine the matter de novo and to make its own decision based on the evidence as at the date of the hearing. Subject to relevance and fairness, this can include information or material that was not available and/or considered when the decision under appeal was made. It can also include evidence that addresses the current circumstances including any changes or improvements made since the decision was made.

The burden of satisfying us that the threshold test under s. 31 (1) is met, and that the decision is justified, necessary and proportionate, lies on the Respondent. The standard of proof ‘reasonable cause to believe’ falls somewhere between the balance of probability test and ‘reasonable cause to suspect’. The belief is to be judged by whether a reasonable person, assumed to know the law and possessed of the information, would believe that a person may be exposed to a risk of harm. It is often described as a low threshold test.

GM and WM v Ofsted [2009] UKUT 89 (AAC) concerned the exercise of the power to suspend under the Childcare Act 2006 in relation to a similarly low threshold test. At [20] Lord Justice Carnwath said that:

There is no definition of “harm” in the Act. It is an ordinary word and needs no gloss. In the overall legislative context of the Act we take “harm” to embrace harm to the health, safety and welfare of service users.

Even if the threshold test is satisfied by the Respondent, that is not an end of the matter because the panel must decide whether the decision is today necessary, justified, and proportionate. The Respondent bears the burden in this regard.

We heard evidence in the following order. All witnesses adopted their statements as their evidence in chief and were asked questions by the other party.

We summarise the main points made.

Dr Deignan relied upon the Respondent’s skeleton. She submitted that there was more than sufficient evidence that satisfied the threshold test regarding harm. The decision was proportionate. There was no evidence or documentation that demonstrated remediation or an up-to-date plan. Conditions were not appropriate in the absence of adequate leadership.

Mrs Schuhmacher submitted that there had never been any safeguarding or medication issues raised by the Local Authority (i.e. the commissioning authority). On 4 February 2026 she was told by Mrs Dunna that she should take the time off to be with her family. She had a plan at the time but had not been given enough time to provide the evidence. Nobody (i.e. no service user) was at risk at all. She was never given a clear understanding of what suspension was. Nobody had come back to her and said that an action plan was needed. There was no reason to suspend the registration. There was no immediate risk to service users.

We will not refer to every aspect of the evidence before us, the skeleton arguments or oral submissions. We have taken all the evidence and submissions before us into account even if we do not specifically refer to every aspect placed before us.

We remind ourselves that we are not today involved in finding facts regarding the alleged breaches. Our first task is essentially that of a risk assessment as at today’s date in the light of all the material before us.

We are an independent panel making a risk assessment as at today’s date against the threshold set out in section 31 (1). We are not concerned with whether harm is “likely” but rather whether or not there “will or may be” a risk of harm to service users.

We have considered with care the records made by Ms Lennon and Mr Swain in their assessments on 19 January 2026. These show that the inspection team had, and had communicated to Mrs Schuhmacher, a number of concerns regarding the standards of care being provided to service users. We consider that these concerns were evidence based. We noted that these concerns had predated the significant medical emergencies which occurred in the week commencing Monday 2 February 2026.

We have considered the evidence of Mrs Dunna and Mr Rielly regarding the nature and substance of the risks posed by the alleged breaches/concerns identified by Ms Lennon and Mr Swain. In summary, the evidence as a whole supports significant concern regarding the standards of care provided.

We have considered the evidence of Mr Rielly regarding his evaluation of risk in the context of the Decision Tree and the Enforcement Policy at section 3A (3) in particular. In our view his assessment of the potential impact of any breaches and the likelihood that the facts giving rise to the breach will happen again was such that the risk engaged is properly regarded as “extreme” is reasonable. This resulted in initial consideration of urgent suspension or the urgent imposition of conditions.

In our experience, any assessment of the significance of risk must take into account that a failure to observe or attend to routine/basic matters in the care of elderly or frail service users may result in serious consequences. It is always necessary to consider the overall context. For example, residents who receive domiciliary care may well be in a different situation to residents in a nursing home. In the latter, individual needs may often be met by a number of carers across shifts, and with “on site” leadership/management overview by a registered manager. Experience informs us that service users whose needs are met in their own home, usually by a single carer, are particularly dependent upon the standards of care delivered by the carer. It is a well-known that the health and well-being of elderly service users can deteriorate rapidly if signs and symptoms are not seen and acted on promptly.

We have considered the nature and substance of the evidence regarding the potential risk of harm to service users. We considered Stage 3B of the Decision Tree (DT) guidance which involves “Identifying multiple and/or persistent breaches” This analysis can result in a change to the initial recommendation for enforcement action by increasing or decreasing the severity. This stage involves consideration of the 3B factors:

3B (1) Has there been a failure to assess or act on past risks?

3B (2) Is there evidence of multiple breaches?

3B (3) Does the provider’s track record show repeated breaches?

3B (4) Is there adequate leadership and governance?

The DT guidance is that, depending on the answers to each of the above, inspectors should make an overall assessment about the most appropriate action to take.

We considered the factors under Stage 3B of the DT guidance which may affect the need for enforcement action. We recognise that it is in the Appellant’s favour that there is no prior history of repeated breaches/enforcement action. No concerns have previously been raised by the commissioning bodies and/or users. However, we are satisfied on the evidence before us that the issues as at the date of decision appear to involve significant and multiple breaches of basic standards of care and significant risk to the safety and wellbeing of service users. In our view the key factor faced by the decision maker was the absence of any adequate oversight, leadership and governance regarding the issue of risk.

We have the utmost sympathy for the acute difficulties that arose regarding the health of Mrs Schuhmacher’s family member. These began on 2 February 2026 and diagnosis was made on 4 February 2026. These health matters had an immediate health impact upon Mrs Schuhmacher. We acknowledge the impact of the health matters before us and how very distressing and worrying this must have been for Mrs Schuhmacher. We refer to our separate decision (protected by restricted reporting order).

As Mr Rielly said it is not at all unusual for the director/provider/nominated individual to be the RM in a small domiciliary agency. In our view what is important, however, is that no matter the size of an agency, there is a robust contingency plan in the event that the one person who fulfils these leadership roles is unable to fulfil the leadership/governance responsibilities of the registered manager because of health/absence. This is the very situation that presented itself on 4 February 2026. Of course, the health crisis was wholly unexpected, and it arose in circumstances that command great sympathy. Whilst we take these matters fully into account, we consider that it is in the nature of adequate contingency planning that a business seeking to provide regulated care services to vulnerable service users must plan for the worst case/unexpected scenario. The issues regarding the adequacy of the care services and contingency planning preceded 2 or 4 February 2026.

Mrs Schuhmacher said in her evidence that she had not asked her GP to sign her off as unfit to work and she had not expected this to happen. She said that it had been her intention to carry on working. She had never intended that her GP would sign her off. She was able to communicate with her staff. She was able to delegate tasks and to speak to her family. As to her fitness (certificate) the GP had said she needed it in place. She had continued to work.

The reality, however, is that Mrs Schuhmacher had informed the Commission that she would not be available. She had also devised and expressly relied on a contingency plan which made MM and KM responsible for leadership and management of the service in her absence. In her oral evidence Mrs Schuhmacher said that she “did not expect the CQC to contact her staff immediately because she had not had time to brief them.”

The thrust of the appeal concerns Mrs Schuhmacher’s complaint that the Respondent’s inspector spoke to MM and KM before (it would appear) Mrs Schuhmacher had had been able to speak to either. Two points arise:

In our view it would have been very surprising indeed had the Respondent not spoken to MM and KM to ensure that the delegation of duties on which Mrs Schuhmacher relied would be effective to protect patient safety. We consider that the Respondent was duty bound to check that the arrangements which Mrs Schuhmacher put forward were appropriate, assured and reliable.

Mrs Schuhmacher in her email communications on 5 February regarding her arrangements had referred to the delegation to KM and MM in the past tense. It is not part of her case that she had ever told the CQC that she had not yet been able to speak to her staff or would need time to do so In our view her complaint that the Respondent acted unfairly in speaking with KM and MM is not well founded.

We do not consider that there is any substance in the suggestion that the Respondent’s decision was “procedurally unfair”.

A further point relied on by Mrs Schuhmacher in her evidence was that there were serious deficiencies in the Out of Hours (OOH) care that was, in fact, put in place by the local authority following the suspension of the Appellant’s registration on 6 January. She contends that following suspension there were shortfalls in the replacement service and she was the only person who was working effectively to protect service users. We recognise, of course, that any changes in the provision of personal care arrangements may carry risk. However, Mrs Schuhmacher had been certified as unfit to work. In our view it is not logical or rational to criticize the Respondent for taking the medical certification provided seriously. We consider that the Respondent had no choice but to respect the certification issued.

In the hearing Mrs Schuhmacher said that she was not informed about the nature of a suspension. We acknowledge that Mrs Schuhmacher has provided evidence with the appeal that seeks to address issues such as certificates regarding training. She also said she was unaware that it was open to her in this hearing to rely on further new evidence such as a new action plan and new policies or arrangements. She made it clear that she had not taken any further steps since the lodging of her appeal to address the Respondent’s concerns. She did not provide any evidence regarding any plan to address the issues of concern held by the Respondent and/or to explain how she envisaged the service will re-open, and/or any revised contingency planning regarding governance and leadership in general, and in the event of any (further) absence.She made clear that she did not consider that any service user had been at risk.

In our view the Respondent’s published Enforcement Policy, which Mrs Schuhmacher said she had read, explains that the purpose of urgent enforcement action is to protect patient safety, and to act proportionately. The Appellant’s case is that Mrs Schuhmacher had provided enough evidence to address the issues of concern but, in our view, the situation faced by the Respondent was that of a service about which there were serious issues which posed significant and immediate risk to the health and safety of service users. In our view there is considerable force in the Respondent’s position that the plan that was put forward by Mrs Schuhmacher did not provide for any or effective leadership or governance in her absence.

In our view the decision to suspend the Appellant’s registration was (and remains) in accordance with the law and was (and remains) plainly necessary and justified in pursuit of a legitimate public interest aim.

The exercise of proportionality requires us to balance the risk of harm to service users against the interests of the Appellant company and others affected. We attach great weight to the protection of residents/service users from exposure to the risk of harm.

Mrs Schuhmacher relied on the fact that she had had a good relationship with Leicester County Council (the LA) for over three years. There had been no safeguarding issues and the LA remains supportive. She told us that the LA do not consider that the suspension was justified but we have seen no evidence from the LA itself. She said that she is ready to restart the business “because it is my only source of income.” She is still in contact with staff and they would like to come back to work for her.

Proportionality requires that the decision maker considers whether less restrictive options could have reasonably addressed the risks involved or could still do so. We considered whether the risks identified could have been met or mitigated by the imposition of conditions or a warning. We do not consider that it was realistic, workable, or practical to formulate conditions. The situation faced by the Respondent was that of the absence of any effective delegated arrangements regarding leadership, and in the context of multiple concerns regarding the safety of service users. We agree with Mr Rielly’s view that to have imposed conditions would have placed the Appellant in jeopardy of being immediately found to be in breach, and at potential risk of criminal sanction. This would have been unfair and inappropriate. A warning would not, in our view, have provided any protection for service users.

Looking at the matter today, and on a de novo basis, we consider that there is little in the material before us today that enables us to conclude that the risks involved in the delivery of a safe service have been addressed adequately or at all. Mrs Schuhmacher’s clear position was that there was never any risk to service users. On the basis of the material before us, whilst making no factual findings, we have formed a different view regarding risk.

We have carefully considered all the matters raised by the Appellant regarding proportionality. We recognise the significant financial impact of the suspension, and not least in the context of the serious health issues before us. We recognise the reputational damage involved in a suspension. We balanced the Appellant’s interests, and the interests of all others affected such as employees, against the risk of significant harm to service users. In our view the Appellant’s interests, and those of others, are outweighed by the need to protect vulnerable service users from the risk of significant harm. We consider that the decision to suspend the Appellant’s registration on an urgent basis was, and remains, wholly proportionate to the risks against which protection to seek to mitigate or reduce the risk of harm should be afforded.

The suspension order continues until 6 May 2026. It is relevant to say that, as stated in the email sent by Jodie Elliott Munday to the Appellant at 13.21 on Friday 6 February 2026 (A29), it is open to the Appellant to contact the Respondent to request an earlier re-assessment. It is, of course, a matter for Mrs Schuhmacher as Director of the Appellant company, and as the registered manager, to decide how she wishes to engage with the Respondent’s concerns, moving forward.