FROM INADEQUATE TO GOOD — OXARA CONSULTING

From Inadequate to Good: A 14-Month Recovery

The Crisis

A well-established nursing home received a Notice of Proposal to cancel registration following an unannounced CQC inspection that 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

The provider had 28 days to submit evidence of immediate improvements or face registration cancellation. 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 deployed on-site within 48 hours of the initial call.

Immediate Actions:

• Conducted governance audit, documenting all breach categories
• Implemented 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.

Client Testimonial: "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 (name withheld)