With a managed live-in care service, the provider is responsible for the care: it assesses needs, writes and reviews the care plan, supervises carers and arranges cover, and it must be registered with the Care Quality Commission (CQC). An introductory agency only introduces a self-employed carer; you or your family then direct and manage the care yourselves, and the agency does not have to register with the CQC. Introductory services can cost less, but more of the responsibility sits with you.
Key facts
- CQC: introductory agencies do not need to register as long as they have no ongoing role in directing or controlling the personal care.
- Having an ongoing role (for example arranging rotas or changing care plans) means the service must register with the CQC.
- The difference is who is responsible for the care, not whether carers are employed or self-employed.
- You can check any registered provider's rating and inspection reports on the CQC website.
What is the difference?
| Managed service | Introductory agency | |
|---|---|---|
| Who is responsible for the care? | The provider | You and your family, with the carer |
| CQC registration | Required | Not required if no ongoing role in the care |
| Needs assessment and care plan | Done and reviewed by the provider | Usually agreed between you and the carer |
| Supervision and spot checks | By the provider | Your responsibility |
| Cover for breaks, holidays and illness | Arranged by the provider | Usually arranged by you, sometimes with agency help |
| Who you pay | The provider (one invoice) | The agency's fee, plus the carer directly |
| If something goes wrong | Provider's complaints process, then the Local Government and Social Care Ombudsman | Depends on your contract with the carer and agency |
How a managed service works
A managed provider meets the person, assesses their needs and risks, and writes a care plan with them and their family. It matches a carer, supervises the care, reviews the plan as needs change and arranges replacement carers. Because it has an ongoing role in directing the care, it is regulated and inspected by the CQC.
How an introductory agency works
An introductory agency finds and introduces self-employed carers, and may check their references and background. After the introduction, the client or family agree the arrangements directly with the carer and direct the day-to-day care. The CQC says these agencies do not need to register as long as they have no ongoing role in directing or controlling the care.
Which is right for you?
A managed service may suit you if needs are complex or changing, family live far away, you want one organisation responsible for safety and cover, or the person is coming home from hospital.
An introductory agency may suit you if needs are stable, a family member is nearby and confident managing the arrangement, and you are comfortable arranging cover and checking the care yourselves.
Questions to ask any live-in care company
- Are you registered with the CQC? What was your latest overall rating, and what did the report say?
- Who writes and reviews the care plan, and how often?
- Who supervises the carer, and how often will someone visit?
- Are your carers employed or self-employed, and who is responsible for the care they give?
- What happens if the carer is ill or needs to leave?
- What exactly is included in the fee, and what is extra?
- What is the notice period, and how do I make a complaint?
How Pinnacle works
Pinnacle is a CQC-regulated care provider and is not an introductory care agency. Our live-in carers are self-employed, and we assess needs, plan and review care and arrange cover. We were rated Good overall by the CQC in August 2025; you can read the full report, including the areas the CQC said we should improve, on the CQC website.
Frequently asked questions
Are carers employed by a managed live-in care company?
Not always. Some managed providers employ their carers; others work with self-employed carers. What makes a service managed is that the provider takes responsibility for the care (assessment, care planning, supervision and cover) and is regulated by the CQC for it. Ask each provider how their carers are engaged.
Is an introductory agency cheaper?
Often, because the agency charges an introduction or placement fee and you pay the carer directly, with no management fee. But you take on tasks a managed provider would do, such as arranging cover, checking the care is safe and changing the care plan.
Does an introductory agency have to be CQC registered?
No, as long as it only introduces carers and has no ongoing role in directing or controlling the care. If it starts doing things like arranging rotas or changing care plans, it must register.
What happens if a carer is ill with an introductory agency?
It depends on your agreement. The agency may help you find a replacement, but arranging cover is usually your responsibility. With a managed provider, arranging cover is part of the service.
Is Pinnacle managed or introductory?
Pinnacle is a CQC-regulated care provider and is not an introductory care agency.
Sources
- CQC: Personal care: ongoing role, introductory agencies and individual care workers (updated 26 May 2022)
- CQC: Pinnacle Caring Services Limited inspection report (21 August 2025)
This guide is general information about care in England. It is not financial, legal or medical advice. Figures were checked on 25 October 2026 and can change.