Regulatory Diagnostic

Know your actual position.

The Nexira Regulatory Diagnostic is a structured, independent review that establishes a provider’s regulatory and operational position from evidence, identifies what requires attention and helps leadership determine what should happen next.

One core framework across eight domains, with scope calibrated to your service and agreed before work begins.

Book an Initial Discussion See What You Receive
Covers
Eight core domains
Scope
Depth calibrated to your service and agreed before work begins
Delivery
Remote, on site or blended, according to scope
Fee
A fixed fee is agreed once the scope is confirmed
Starts with
A complimentary initial discussion

When it helps

When a Diagnostic helps.

For established adult social care providers in England who need independent clarity about where they stand. It is as useful for a service that is broadly stable as for one under pressure.

  • Concerns are emerging, but the underlying causes or scale are unclear.
  • Issues keep returning even though actions have been recorded as completed.
  • Governance activity is taking place, but leaders are not confident that it provides reliable assurance.
  • Growth, multiple locations or operational change have made oversight more complex.
  • Leadership wants an independent view of the current position before regulatory scrutiny or significant change.
  • Several concerns overlap and leadership needs clarity about what should be prioritised first.

Choosing the right starting point

When you may not need a Diagnostic.

The Diagnostic is a common starting point, not a requirement. If your need is already defined, going directly to the relevant service is often the better route.

Where the requirement is limited to one clearly defined issue, Nexira can scope that work separately.

What Nexira examines

Eight domains, examined together.

The Diagnostic uses eight core domains to build a rounded view of the provider’s position. The depth of review across them is calibrated to your service, its evidence and the concerns that prompted the work.

  1. Governance

    Leadership oversight, understanding of risk, decision-making and organisational control: how leaders know what is happening, and act on it.

  2. Leadership

    Whether responsibilities are clear, managers are supported and leaders can demonstrate effective oversight and follow-through.

  3. Workforce

    Whether recruitment, induction, training, supervision, competency and performance arrangements support a safe, competent and effective workforce.

  4. Care Delivery

    Whether care is safe, effective, person-centred and responsive to people’s needs, choices and risks, and whether assessments, care planning and reviews reflect what happens in practice.

  5. Safeguarding

    How concerns are identified, escalated and investigated, and how they are translated into organisational learning.

  6. Medicines

    Whether medicines support is person-centred and safely managed, including staff competency, records, individual arrangements, incidents, monitoring and corrective action.

  7. Quality Assurance

    How quality is checked, how patterns are identified, how learning happens and whether improvement is tested.

  8. Evidence & Records

    Whether the information relied upon is accurate, complete, current and consistent, and capable of supporting assurance.

Three domains that are easily confused

Governance
asks how leadership knows what is happening and acts on it.
Quality Assurance
asks whether the checks find what matters and lead to improvement that holds.
Evidence & Records
asks whether the information itself can be relied on.

How evidence is considered

Beyond the existence of systems.

Systems and processes are necessary. On their own, they are not assurance. Nexira builds a rounded picture through six broad evidence lenses.

  • People

    The experience of the people who use the service, and of those close to them.

  • Staff

    What staff and leaders understand, describe and do.

  • Partners

    What professionals and partner organisations see and report.

  • Practice

    What is happening in day-to-day care, beyond what is recorded.

  • Process

    The systems, policies, records and governance arrangements in place.

  • Outcomes

    Whether the intended results for people and for the service are being achieved.

These are Nexira’s own lenses for building an independent view. They are not a replica of the regulator’s evidence categories, and the Diagnostic is not an inspection.

How evidence may be tested

Depending on the agreed scope, Nexira may use evidence review, conversations, practice observation, record-to-practice testing, triangulation across sources and proportionate targeted sampling.

Recorded is not the same as working

Assigned is not Completed, is not Verified, is not Closed.

The Diagnostic tests whether actions recorded as complete are verified and working, not only whether they are marked as done.

About the Nexira Method

How it works

How the Diagnostic works.

Scope and fee are agreed before work begins. What happens after the findings is your decision.

  1. Initial discussion

    A complimentary conversation to understand what has prompted the enquiry, whether a Diagnostic appears appropriate and the broad scope. It is not a free Diagnostic, an evidence review or a detailed advice session.

  2. Scope agreed

    The services or locations, depth, delivery approach and fixed fee are agreed in writing before work begins.

  3. Evidence and targeted testing

    Nexira reviews the evidence requested and tests it proportionately against practice, people’s experience and outcomes, within the agreed scope.

  4. Analysis and prioritisation

    Findings are brought together across the Diagnostic framework, and priorities are established.

  5. Findings

    The written Diagnostic findings set out the current position, strengths, priority risks and how far the evidence can be relied on.

  6. Leadership discussion and next steps

    A structured discussion with leadership about the findings and the appropriate next steps.

What you receive

Six outputs, from every Diagnostic.

Captured in the written Diagnostic findings and the leadership findings discussion.

  1. Current-position assessment

    A clear assessment of the provider’s position against the agreed Diagnostic scope.

  2. Strengths and areas requiring attention

    What appears to be working, alongside the areas that need further attention.

  3. Priority risks and assurance gaps

    The regulatory and operational risks or gaps that require priority attention.

  4. Evidence-strength findings

    Where the evidence gives confidence, and where it is insufficient, inconsistent or needs further assurance.

  5. Prioritised recommendations

    Clear recommendations showing what should be addressed first. This is not automatically a detailed implementation action plan.

  6. Leadership findings and recommended next steps

    A structured leadership discussion of the findings and the appropriate next steps.

Always included

  • Eight-domain Diagnostic framework
  • Calibrated evidence review and testing
  • Written Diagnostic findings
  • The six outputs above
  • A leadership findings discussion

Calibrated to scope

  • Volume of evidence
  • Depth of sampling
  • Number of services or locations
  • Number of conversations
  • On-site activity
  • Thematic depth

Not automatically included

  • A full implementation action plan
  • Implementation support
  • An improvement programme
  • Re-verification
  • Ongoing assurance
  • A coaching programme

These can be scoped separately where appropriate.

The Diagnostic does not produce CQC-style ratings, compliance percentages, RAG scores, grades, rating predictions or certificates.

Afterwards

What happens next is your decision.

The Diagnostic is designed to be useful on its own. You are not required to commission further support from Nexira.

After receiving the findings, a provider may:

Boundaries

Independent, and clear about its limits.

  • Nexira is an independent consultancy. It is not part of, affiliated with or endorsed by the Care Quality Commission (CQC).
  • The Diagnostic is not a CQC inspection and does not produce a CQC rating.
  • It does not guarantee any regulatory outcome.
  • Findings reflect the evidence available and the scope agreed.
  • The provider retains regulatory and operational accountability for its services.
  • Nexira does not provide legal advice.

Diagnostic FAQ

Questions about the Diagnostic.

No. It is a common starting point when the position is unclear. Where the need is already defined, you can go directly to the relevant service.

No. It is an independent consultancy review using Nexira’s own framework. It does not replicate CQC’s assessment approach and does not produce a rating.

No. CQC makes its own independent decisions. The Diagnostic provides an independent assessment of what the evidence indicates about your current position and what should be prioritised.

A fixed fee is agreed once the scope is confirmed. The initial discussion is complimentary.

Yes. One engagement can cover more than one service or location, with scope and depth calibrated accordingly.

It can be delivered remotely, on site or through a blended approach, according to the agreed scope.

It includes prioritised recommendations showing what should be addressed first. A full implementation action plan, and support to deliver it, can be scoped separately if needed.

Start with a conversation.

Tell Nexira what has prompted you to look more closely. The initial discussion establishes whether a Diagnostic is the right starting point.

Book an Initial Discussion Discuss What You Need