Case-study note: the provider and service have been anonymised to protect confidentiality. The account is based on contemporaneous regulatory correspondence, operational records and engagement documentation retained by Oxara.
Outcome at a glance
Following an Inadequate rating and a Notice of Proposal to cancel registration, the service underwent immediate risk stabilisation, four months of embedded leadership and a sustained quality-improvement programme. CQC later withdrew the proposed cancellation action, and the service achieved a Good overall rating after 14 months.
Position
CQC had served a Notice of Proposal to cancel the provider’s registration. The provider had 28 calendar days from service of the notice to submit written representations and supporting evidence.
CQC Rating: Inadequate (with enforcement action pending)
With no Registered Manager in post and a demoralised staff team, they risked losing their business entirely.
What the evidence showed
An unannounced CQC inspection had identified:
- Inadequate medication management (medicines administration records containing missing signatures and dose-recording discrepancies)
- Insufficient safeguarding protocols (staff unable to describe reporting procedures)
- Poor infection control (shared equipment not cleaned between residents)
- Lack of clinical oversight (night-shift rotas contained periods without the registered-nurse coverage required to meet residents’ assessed nursing needs)
- Ineffective leadership (Registered Manager on long-term sick leave)
Intervention
Phase 1: Crisis Stabilisation (Week 1)
Roxana Rosca was deployed on-site within 48 hours of the initial call.
- Conducted a governance audit, documenting all breach categories
- Introduced 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)
- Submitted Roxana Rosca’s application to CQC for registration as manager while she provided interim operational leadership
Week 1 deliverable: A 15-page written submission to CQC setting out the immediate risks identified, remedial actions completed, responsible persons, timescales and supporting evidence, including dated documentary and photographic evidence where appropriate.
Phase 2: Interim Leadership (Months 1–4)
Roxana assumed interim operational leadership and applied to become the service’s registered manager. CQC approved the registration within three weeks, and she provided full operational leadership throughout.
- 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)
Phase 3: Quality Improvement Programme (Months 5–10)
Transitioned to monthly consultancy support while permanent RM embedded.
- 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)
Position established
- Month 3CQC conducted follow-up inspection and confirmed immediate risks had been addressed. Notice of Proposal withdrawn.
- Month 14
CQC conducted a full announced inspection.
The service was rated Good overall, with Well-led remaining Requires Improvement because leadership arrangements had only recently stabilised.
Inspection finding: CQC found that 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)