From Inadequate to Good: A 14-Month Recovery
42-Bed Nursing Home · South East England
The Crisis
A Notice of Proposal to cancel registration. The provider had 28 days.
An unannounced CQC inspection had identified:
- Inadequate medication management (missing signatures, incorrect dosages)
- Insufficient safeguarding protocols (staff unable to describe reporting procedures)
- Poor infection control (shared equipment not cleaned between residents)
- Lack of clinical oversight (no registered nurse on duty during night shifts)
- Ineffective leadership (Registered Manager on long-term sick leave)
CQC Rating: Inadequate (with enforcement action pending)
The Challenge
With no Registered Manager in post and a demoralised staff team, they risked losing their business entirely.
Our Intervention
Phase 1: Crisis Stabilisation (Week 1)
Roxana Rosca was deployed on-site within 48 hours of the initial call.
Immediate Actions
- Conducted a governance audit, documenting all breach categories
- Implemented an immediate medication management protocol (double-checking system, electronic MAR charts)
- Delivered urgent safeguarding training to all staff (100% attendance within 72 hours)
- Established infection control champion system with daily equipment audits
- Introduced 24/7 senior clinical coverage (agency clinical staff secured within 48 hours)
- Applied for CQC Registered Manager registration (Roxana Rosca as Interim RM)
Week 1 Deliverable: 15-page written submission to CQC structured around processes and feedback from staff evidence areas, with photographic evidence of every action taken.
Phase 2: Interim Leadership (Months 1–4)
Roxana registered as the home's Interim Registered Manager (approved by CQC within 3 weeks) and provided full operational leadership.
Key Actions
- Rewrote all clinical policies (medication, infection control, safeguarding, clinical observations)
- Implemented weekly clinical governance meetings with documented minutes
- Conducted competency assessments for all care staff (12 staff required remedial training)
- Introduced daily handover protocols between shifts with written records
- Established resident and family communication system (monthly newsletters, satisfaction surveys)
- Recruited permanent Registered Manager (6-week structured handover period)
Evidence Outcome: CQC conducted follow-up inspection at Month 3 and confirmed immediate risks had been addressed. Notice of Proposal withdrawn.
Phase 3: Quality Improvement Programme (Months 5–10)
Transitioned to monthly consultancy support while permanent RM embedded.
Focus Areas
- Staff retention programme (supervision structure, training budget, career progression)
- Care planning overhaul (person-centred assessments, risk management, outcomes monitoring)
- Quality assurance system (monthly audits, action tracking, board reporting)
- Local authority relationship rebuilding (placement suspensions lifted after 6 months)
Phase 4: Re-Inspection and Rating Improvement (Month 14)
CQC conducted full announced inspection.
Inspection Outcome
- Overall Rating: Good
- Safe: Good
- Effective: Good
- Caring: Good
- Responsive: Good
- Well-led: Requires Improvement (due to recent leadership changes)
Inspector Feedback: The provider had made significant improvements since the last inspection, with effective clinical leadership and a positive culture of learning.
"Roxana saved our business. When we received the Notice of Proposal, we thought we'd lose everything. She didn't just tell us what to do — she rolled up her sleeves and did it alongside us. Fourteen months later, we're Good rated and our occupancy is back to 95%. We couldn't have done this without her."
— Provider Director, 42-bed nursing home, South East England (name withheld)