Providers can and should measure quality in many ways, but the opinion that truly counts is the Care Quality Commission’s, as a poor rating can prevent a service from getting local authority contracts and private work alike, or even force them to close. This is a particularly frustrating situation when many services have remained unrated or stuck with out-of-date scores for years. To then finally get the inspection you’ve been waiting for only for it to go horribly and leave the service with a rating of Requires Improvement or even Inadequate is a disheartening experience, to say the least.
When inspectors arrive, services must be ready with clear evidence that demonstrates compliance, good outcomes and improvement. Yet providers can think they are ready and still be ambushed by poor ratings and an excoriating report. Internal audits suggest everything is fine, feedback from people and their relatives is positive, online review scores are high. So what the heck went wrong? When an inspection report is much worse than expected, what can be done?
First a quick word from my sponsor, that is, me. 🙂
I provide support with factual accuracy challenges, post-inspection action planning, and turnaround work when things have gone badly wrong. Services can commission mock inspections, recovery checks and full audits that mirror what inspectors will do, with clear reports and practical recommendations. You can join the Z Cares Family for regular support and mentoring as well as other perks such as half price consultancy and free access to the app.
The Z Cares App (the Zapp!) has been designed to help managers stay inspection-ready every day. The Zapp includes an auditing module aligned to the CQC Single Assessment Framework, plus specific tools such as an Accessible Information Standard audit and a Commitment to Cleanliness Charter tool aligned with the National Standards of Healthcare Cleanliness 2025.
And now, back to the advice…
The Factual Accuracy Challenge
It is tempting to believe an inspector simply “got it wrong.” Occasionally they do, so it’s important to understand why they said what they did. Most negative judgments fall into one of two categories:
- There is evidence of poor/unsafe practice.
- There is no evidence of good/safe practice.
There are very good safeguarding and other practical reasons why “if it ain’t written down, you didn’t do it” is a cliche in our sector. Regulators cannot assume quality where records are missing, audits are incomplete or oversight is weak. Even if staff insist that people are well cared for, without the evidence the regulator is correct to conclude there is no assurance of safe practice.
Registered managers must treat evidence as their responsibility as it is their good name on the line as well as the provider’s. It is not enough for care to be good, the systems need to show it. Paper records are often messy and incomplete, while electronic systems can bury key information in the wrong place. If an inspector cannot find the evidence, they cannot credit it. It is not a valid defence that your staff knew the missing information in their heads and it was always immensely frustrating as an inspector to have to write in a report that, “People’s care plans and assessments did not reflect the staff’s detailed knowledge of their needs and preferences.”
A factual accuracy challenge (FAC) can only succeed where you can show that evidence existed and was misinterpreted or overlooked. Here are some examples based on real-life scenarios I’ve encountered over the years as a care worker, inspector and consultant:
- A person was described as at risk of malnutrition because charts were incomplete, but the person was not at risk at all and the partially filled paper charts were an error by a new member of staff which had actually been identified at audit and addressed (with records to prove this, of course!)
- A judgment stated that pressure care plans were not in place, but they existed under separate tissue viability section that the inspector did not access.
- Two clients of the service with the same name had been conflated.
- A relative known for making false complaints (to the extent that Safeguarding were involved in the breakdown of previous care and it was noted in their referral) was spoken to and their feedback was uncritically used as evidence of poor practice.
In these cases, the FAC should clearly present the evidence, explain where it is located, and show how it addresses the inspector’s concern. (Also: I shouldn’t have to explain this, but it happened to me on more than one occasion so I will… don’t send documents as FAC evidence that you’ve added to since the inspection and claim they were the ones seen by inspectors. They take photos. Of course they do.)
A FAC cannot defend the indefensible. If the evidence does not exist or if records show unsafe practice, the judgment will not be overturned and your energies are best spent on fixing the issues: the only option is improvement, not argument. If you want to discuss whether you have FAC-worthy evidence, please get in touch for my honest opinion.
Risks Were Not Recognised
Another common issue is a failure to appreciate the seriousness of an issue or for there to be a complete blind spot as to the risk, resulting in a “textbook” breach of Regulation 12 (safe care and treatment) as this covers basic safety, safeguarding, risk assessment and medicines.
Good practice evolves, and services must keep up. You should work to the regulations and latest guidance, and not assume that because something was ok at the last inspection that it should have been accepted this time. It’s useful to note that inspectors are dipsticks. No, seriously, bear with me, it’s an engine inspection metaphor, honest! They have different areas of expertise and interests and although working to the same standards will obviously put areas they know well under more expert scrutiny – a nurse will naturally go through your medicines management like a physic and you should be confident that your PEEPs could impress an ex-fireman.
Quality Assurance Gaps
Quality assurance should be evidence-based and honest, not a box-ticking or trumpet-blowing exercise. The best services are such partly because they identify their strengths and weaknesses and maintain live improvement plans that respond to real issues.
QA failures are often caused by gaps in skill or knowledge. Auditors may be experienced in care but untrained in auditing, or be skilled administrators who do not fully grasp the risks or what good care reads like. This can mean issues are missed and it is the presence of information that is audited, rather than the quality of it.
Providers should also ask: who audits the auditors? Delegating QA without oversight can create blind spots. Where a service is too small to employ a dedicated QA manager, peer reviews can help. Managers from similar services can act as each other’s critical friends and highlight risks before an inspector does.
The Zapp supports this by providing structured, evidence-based audits that reduce reliance on individual interpretation. When combined with an external mock inspection from Z Cares, this gives managers a clear and realistic picture of how their service stands up to scrutiny. Z Cares Family members will also be able to access a private forum through the app to discuss concerns with me and other members.
Leadership, Culture and Governance
Inspection outcomes are shaped not only by frontline practice but also by leadership culture. Inspectors expect managers to show how they know their service is safe and effective. That means governance systems which track risks, respond to concerns and demonstrate learning from incidents.
A healthy culture encourages staff to speak openly about challenges. If managers are defensive or dismissive of problems, issues go unresolved and inspectors notice. Strong leadership is visible, accountable and committed to continuous improvement.
Reading Between the Lines of Feedback
Positive feedback can be misleading. Families and people may be reluctant to criticise, may only see part of the service, or may downplay concerns out of guilt or concern about the consequences of raising complaints.
Even five-star reviews should be read critically – praise for staff kindness and the home’s cleanliness is welcome, but does not prove safe practice or compliance! Managers must analyse reviews with a questioning eye and look for what is unsaid as well as what is said. They should also look for evidence of cracks forming, such as comments that indicate staff numbers have been cut to the bone, e.g. “everyone is kind but very rushed” and “the food is lovely but always cold by the time mum gets helped”.
Staying on Top of your Evidence
Managers are ultimately responsible for knowing what evidence exists and ensuring it is accessible. That means:
- Ensuring key records can be located quickly.
- Making sure staff understand what to record, where to record it, and why it matters.
- Identifying gaps before inspectors do.
External support can make this easier. Many managers are too close to their own systems to spot flaws and a fresh set of eyes can reveal where evidence is missing, misfiled or poorly presented. Particularly if you are combining the roles of Registered Manager and Nominated Individual, there can be a complete lack of external opinion and this must be addressed. The CQC should never be the first people to audit your paperwork or judge your practice.
Inspection Readiness and Recovery
The best protection against poor outcomes is constant readiness. Services should carry out regular audits and mock inspections, whether through internal reviews, peer networks or external consultancy. A simple question to ask is: if an inspector walked in today, what would we be able to show?
If the outcome is still disappointing, the response is just as important:
- Prioritise a clear action plan and share it with staff.
- Communicate honestly with families about what is being done.
- Keep morale up by emphasising learning and improvement, not blame.
Z Cares can provide practical support at every stage of recovery. This includes developing action and improvement plans, supporting services in communicating with regulators and commissioners, and checking whether issues have really been resolved. Supporting staff wellbeing during interesting times is also vital. For services in turnaround or crisis, I offer more intensive support to rebuild your service on the rock.
TLDR
Poor ratings rarely come out of the blue. They usually reflect evidence of unsafe practice, a lack of evidence of good practice, or blind spots in leadership and assurance. The key to preventing bad reports is to treat inspection as an ongoing state of readiness, not a one-off event, and to build a culture where evidence, openness and improvement are part of daily practice.
For providers who want support, Z Cares offers consultancy, mock inspections and peer review, recovery checks and detailed audits. The Zapp adds daily assurance by making audits, cleanliness checks and compliance tools part of everyday management.
Please get in touch if I can help in any way.
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