When a Care Home Manager Is Underperforming: The True Cost of Poor Leadership and How to Address It

A practical guide for care providers on managing poor performance, protecting care standards and knowing when interim leadership could be the right solution.

Introduction: When poor management becomes a risk to care

Managing poor performance in a care home is one of the more difficult challenges facing care providers. Whether you're dealing with an underperforming Care Home Manager, considering a formal performance improvement plan or facing the prospect of replacing a Home Manager, it's important to understand the steps you can take to protect residents, support staff and maintain CQC compliance throughout the process

Unlike many other industries, where underperformance might primarily affect productivity or profitability, poor leadership in a care home can directly influence the quality, safety and consistency of care delivered to vulnerable people.

A struggling Home Manager can affect almost every aspect of a service, from staff morale and retention to medication governance, safeguarding, occupancy, financial performance and ultimately the home's regulatory standing.

The challenge for providers is knowing when to support a manager to improve, when more formal action is necessary and, perhaps most importantly, how to protect the home and its residents throughout that process.

Managing an underperforming manager is not simply an HR issue. It is an operational, commercial and quality-of-care issue that requires a carefully considered response.

1. Recognising the early warning signs

Poor performance rarely happens overnight. More often, there are warning signs that become increasingly apparent over weeks or months.

The difficulty is that some of these indicators can initially appear relatively minor when considered individually.

Common signs that a Home Manager may be struggling include:

Quality and compliance concerns

Repeated failures to complete audits or follow through on identified actions.
Increasing medication errors, safeguarding concerns or incidents.
Poor preparation for regulatory inspections.
Inconsistent care planning, documentation or risk assessments.
Recurring issues being identified without evidence of sustained improvement.

People management and culture

Rising staff turnover or increasing sickness absence.
Low morale and deteriorating relationships between management and care teams.
Excessive reliance on agency staff.
A reluctance to address poor performance within the wider team.
Complaints from employees, residents or relatives about communication or leadership.

Operational and commercial performance

Falling occupancy or weak enquiry conversion.
Increasing agency expenditure and poor control of staffing budgets.
Missed operational targets.
Inaccurate reporting or a lack of visibility over performance.
An inability to implement agreed improvement plans.

Of course, none of these indicators automatically means that the Home Manager is solely responsible.

Providers need to consider the wider circumstances, including staffing shortages, funding pressures, the level of regional support available and whether the manager has been given the resources and authority needed to succeed.

Nevertheless, where multiple warning signs are present, early intervention is essential.

2. The hidden cost of allowing poor performance to continue

One of the biggest mistakes a care provider can make is allowing an underperforming manager to remain in post indefinitely without a clear improvement plan.

There is often an understandable reluctance to act. Replacing a Home Manager can be disruptive, recruitment takes time and there may be concerns about how a change in leadership will affect the team.

However, delaying action can create a much greater problem.

The impact on residents

A Home Manager sets the tone for the entire service.

Where leadership is inconsistent, the quality of oversight can deteriorate. Care plans may not be reviewed effectively, incidents may not receive appropriate scrutiny and staff may become unclear about expectations or accountability.

Over time, these weaknesses can increase the risk of avoidable harm, safeguarding concerns and poorer outcomes for residents.

The impact on staff

Good employees want to work in well-led environments.

When management is ineffective, experienced staff can become frustrated by a lack of direction, inconsistent decision-making or unresolved problems.

This can lead to increased absence, disengagement and ultimately the loss of valuable team members.

Once a home develops a reputation for poor leadership, attracting replacements can become increasingly difficult.

The impact on regulatory compliance

Under the CQC's assessment framework, leadership and governance are central to demonstrating that a service is well-led.

Weak governance, ineffective oversight and a failure to act on identified risks can contribute to regulatory concerns.

An underperforming manager does not automatically result in a poor CQC rating, but prolonged management weaknesses can leave a provider exposed to enforcement action, reputational damage and additional scrutiny.

The commercial impact

Poor management can also create significant financial consequences.

A home experiencing high staff turnover, increasing agency costs and falling occupancy can see profitability deteriorate quickly.

Where performance issues become entrenched, the cost of recovery can be considerably higher than the cost of intervening early.

The real question for a provider is not simply what it costs to replace an underperforming manager, but what it costs the business, its staff and its residents to leave the situation unresolved.

3. Managing Poor Performance in a Care Home: Support, Accountability and Performance Improvement Plans

Not every underperforming Home Manager needs to be replaced.

In many cases, the right support, clearer expectations and a structured improvement plan can help an individual regain confidence and deliver the required standards.

Before beginning a formal process, providers should establish whether the concerns relate primarily to capability, conduct or factors outside the manager's control.

These distinctions matter because the appropriate HR process may differ.

Start with an honest assessment

A Regional Manager, Operations Director or other appropriate senior leader should review the available evidence.

This might include audit findings, staffing data, financial performance, complaints, quality indicators, supervision records and previous discussions about performance.

The purpose should be to identify specific, demonstrable gaps rather than relying on subjective impressions.

Establish a performance improvement plan

Where appropriate, a structured Performance Improvement Plan (PIP) should clearly identify:

The areas where performance is below expectations.
The standards the manager is required to achieve.
The support, coaching or training that will be provided.
Realistic timescales and measurable objectives.
How progress will be reviewed.
What may happen if the required improvements are not achieved.

For example, rather than asking a manager to "improve governance", a plan could require outstanding high-risk audit actions to be addressed within agreed deadlines, with evidence reviewed at weekly governance meetings.

Expectations should be achievable, clearly communicated and proportionate to the circumstances.

Review progress consistently

Regular review meetings provide an opportunity to assess improvement, identify obstacles and document decisions.

Where meaningful progress is being made, providers should recognise that improvement and consider whether further support is appropriate.

Where performance continues to fall below the required standard, more formal capability procedures may become necessary.

Importantly, the process should remain fair, evidence-based and consistent with the provider's policies and employment law.

4. Practical checklist: Managing poor performance and considering dismissal

The following checklist provides a structured approach for care providers dealing with persistent management underperformance.

It is designed to help senior leaders manage the process fairly while maintaining appropriate oversight of the service.

Stage 1: Establish the facts

Identify the specific areas of underperformance and gather supporting evidence.
Review relevant audits, complaints, incident reports, financial information and previous performance discussions.
Consider whether the concerns relate to capability, misconduct or a combination of factors.
Establish whether appropriate support, resources and training have previously been provided.
Consider any health, disability or other relevant circumstances and whether reasonable adjustments are required.
Assess whether there are immediate risks to residents, staff or the safe operation of the home.
Where serious allegations are involved, consider whether temporary alternative duties or precautionary suspension are necessary, reasonable and proportionate.

Key consideration: Any immediate safeguarding or safety concerns must be managed promptly, independently of the employment process.

Stage 2: Communicate concerns and establish expectations

Arrange an appropriate meeting to discuss the identified concerns.
Explain the performance issues clearly, using specific examples and supporting evidence.
Give the manager a fair opportunity to respond and provide their perspective.
Explore any underlying reasons for the performance difficulties.
Agree a structured improvement plan where appropriate.
Set measurable objectives, review dates and realistic timescales.
Confirm expectations and potential consequences in writing.

Key consideration: The objective should be to achieve improvement wherever reasonably possible, rather than treating dismissal as a predetermined outcome.

Stage 3: Follow a fair formal procedure where necessary

Review the evidence and determine whether formal capability or disciplinary action is appropriate.
Invite the manager to a formal hearing in writing, giving sufficient information about the concerns and possible outcomes.
Provide relevant evidence in advance and allow reasonable preparation time.
Explain the right to be accompanied by an eligible trade union representative or workplace colleague.
Ensure the hearing is conducted by an appropriate, impartial person.
Present the concerns and give the manager a genuine opportunity to respond.
Consider any explanations, mitigating circumstances and further evidence before reaching a decision.

Key consideration: Capability and misconduct should not automatically be treated as the same issue. The procedure must reflect the nature of the concern.

Stage 4: Decide on the appropriate outcome

Consider whether further coaching, training, adjustments or an extended improvement period would be appropriate.
Determine whether a formal warning is justified under the provider's policies.
Consider whether the manager has had a reasonable opportunity to improve.
Where dismissal is being considered, review the evidence, procedural fairness and any reasonable alternatives.
Ensure the decision is proportionate and consistent with the circumstances.
Confirm the outcome and reasons in writing.
Explain any applicable notice arrangements and the right of appeal.

Key consideration: Dismissal for capability will ordinarily involve the appropriate notice or payment in lieu. Dismissal without notice is generally reserved for established gross misconduct following a fair process.

Stage 5: Manage any appeal fairly

Explain how and when an appeal can be submitted.
Arrange an appeal hearing without unreasonable delay.
Where possible, appoint a manager who has not previously been involved and is sufficiently senior.
Allow the employee to be accompanied.
Review the grounds of appeal and any relevant new evidence.
Confirm the final internal decision in writing.

Key consideration: Appeal timescales should follow the organisation's policies and be reasonable. There is no universal statutory requirement for an appeal to be heard within five working days.

Stage 6: Protect the service throughout the process

Identify who will retain day-to-day operational accountability.
Confirm arrangements for CQC registered management and any required notifications.
Establish clear oversight of safeguarding, medication, staffing and quality governance.
Agree who will communicate with staff, residents, relatives and external stakeholders.
Consider whether temporary additional management support is needed.
Prepare a contingency plan should the manager leave or be unable to continue in post.
Review whether an experienced Interim Home Manager could provide continuity and stability.

Key consideration: The employment process and the operational needs of the care home must be managed together. Residents should not experience a reduction in care quality because of uncertainty surrounding the manager's position.

5. The difficult question: What happens to the home while the process is ongoing?

This is where many care providers face their biggest challenge.

A formal performance management process can take weeks or months, depending on the circumstances.

During that period, the provider must continue to maintain safe staffing levels, meet regulatory requirements, support employees, manage budgets and deliver high-quality care.

If the existing Home Manager is struggling to maintain those standards, simply waiting for the HR process to conclude may not be a viable operational strategy.

Regional Managers and Operations Directors often step in to provide additional support, but this can create further pressures.

Time spent managing one underperforming service is time taken away from supporting other homes, delivering improvement programmes and progressing wider business objectives.

And if the manager eventually leaves, the provider can find itself facing a second challenge: an unexpected leadership vacancy at a home that may already require significant improvement.

This is precisely where interim management can offer a practical solution.

6. "How an Interim Care Home Manager Can Support Service Stabilisation and Care Home Turnaround"

An experienced Interim Home Manager can provide additional leadership capacity during a period of uncertainty, whether that involves supporting a struggling service, covering a management vacancy or leading a more substantial improvement programme.

For care providers dealing with an underperforming manager, interim leadership can offer several important advantages.

Immediate operational stability

Rather than leaving a home without sufficient management oversight, an experienced interim can take responsibility for agreed operational priorities and establish clear accountability.

This is particularly valuable where the existing manager has left, is absent or where an appropriate temporary management arrangement is required.

An independent assessment of the service

An interim leader brings a fresh perspective.

Without the same historical relationships or internal pressures, they can review the home's current position, identify the most pressing risks and provide senior leadership with an objective view of what needs to change.

This can be particularly valuable where a service has experienced prolonged management difficulties.

Strengthening quality and governance

Experienced interim managers can help re-establish the disciplines that support safe, effective care.

These might include:

Reviewing outstanding quality and compliance actions.
Strengthening safeguarding and incident management oversight.
Improving medication governance and audit follow-through.
Re-establishing effective staff supervision and accountability.
Supporting inspection readiness and regulatory improvement plans.
Improving reporting and communication with regional leadership.

Rebuilding confidence within the team

A period of poor leadership can have a lasting impact on staff morale.

An effective interim manager can bring consistency, visibility and clear expectations, helping staff regain confidence in the home's direction.

Providing time to make the right permanent appointment

Perhaps one of the most significant benefits of interim leadership is the breathing space it provides.

When a manager leaves unexpectedly, providers can feel under pressure to recruit quickly.

That pressure can result in compromises around experience, leadership style or cultural fit.

An interim appointment allows the provider to stabilise the home while conducting a thorough permanent recruitment process.

The objective is not simply to fill a gap. It is to protect the service while creating the conditions for a stronger long-term appointment.

7. What should an Interim Home Manager achieve in their first 30 days?

A good interim appointment should be built around clear objectives and measurable outcomes.

While every home will have different challenges, an effective initial plan could look like this.

Days 1–7: Understand the risks and establish control

The interim should review immediate safeguarding concerns, staffing arrangements, medication management, outstanding incidents, quality audits and any regulatory actions.

They should meet key staff, establish reporting lines and agree the most urgent priorities with the provider.

Days 8–14: Address immediate weaknesses

Attention should turn to unresolved high-risk issues, strengthening governance arrangements and establishing clear expectations with the team.

A structured action plan should be in place, with named owners and agreed deadlines.

Days 15–21: Build consistency and accountability

The interim should establish regular management meetings, improve oversight of quality indicators and support the team in embedding more consistent working practices.

Commercial indicators, including agency usage, occupancy and staffing expenditure, should also be reviewed where relevant.

Days 22–30: Demonstrate progress and establish the next phase

By the end of the first month, the provider should have a much clearer understanding of the home's position.

There should be evidence of improved oversight, progress against immediate risks and a prioritised plan for the following 60–90 days.

Not every underlying problem can be resolved in 30 days, but the provider should have greater visibility, stronger accountability and a clear direction of travel.

8. How Leaders in Care can support providers facing management challenges

If you're considering replacing a Care Home Manager, dealing with an unexpected resignation or need an emergency Interim Home Manager to support a struggling service, Leaders in Care can help you find experienced leadership support. Our interim professionals can assist with CQC improvement plans, care home turnaround projects, operational recovery and maintaining continuity of care during management transitions.

Sometimes the right approach is to provide additional support to the existing manager. In other circumstances, a provider may need to make a change and bring in experienced leadership to stabilise the service.

Our interim management recruitment solution is designed to support providers through those periods of uncertainty.

We work with experienced interim care leaders who can support organisations with:

Emergency management cover: Providing continuity when a Home Manager leaves unexpectedly or is unable to remain in post.
Service stabilisation: Bringing experienced leadership into homes experiencing operational or management difficulties.
CQC improvement and turnaround: Identifying weaknesses, strengthening governance and implementing structured improvement plans.
Leadership transitions: Maintaining consistency while a provider works through management changes or recruits a permanent replacement.
Additional operational support: Providing experienced leadership capacity when regional teams are stretched.

We understand that providers do not always have the luxury of time when a home requires additional leadership.

That's why we focus on identifying suitable, experienced interim professionals who can mobilise quickly, often within days, depending on the assignment and availability.

Importantly, we look beyond simply whether someone has held a Home Manager title.

We consider the environments they have worked in, the challenges they have managed, their experience of service improvement and whether they have the leadership skills needed for the specific situation.

Our aim is to help providers maintain continuity, protect care standards and regain operational confidence while they work towards a longer-term solution.

9. Final thoughts: Acting early protects more than performance

Managing an underperforming Home Manager is never an easy decision.

Providers must balance fairness to the individual with their responsibilities to residents, staff and the wider organisation.

Where improvement is achievable, managers should receive appropriate support and a genuine opportunity to succeed.

However, when concerns persist or the risks to the service become significant, delaying action can have serious consequences.

The strongest providers are those that recognise emerging problems, address them fairly and have contingency arrangements in place before a management issue becomes a wider operational crisis.

A leadership problem does not have to become a care quality crisis.

With the right support, clear accountability and access to experienced interim leadership when required, providers can protect their services while making considered, long-term management decisions.

Need additional leadership support in one of your care homes?

If you're currently managing concerns about a Home Manager's performance, preparing for a leadership change or simply need experienced management support to stabilise a service, Leaders in Care can help.

Our interim management team can work with you to understand the challenges within your home and identify an experienced interim professional suited to the situation.

Whether you need short-term management cover, specialist turnaround experience or additional operational leadership, we can help you explore the options.

Speak to Leaders in Care for a confidential, no-obligation conversation about your interim management requirements.

Leaders in Care | Specialist Recruitment & Interim Management Solutions for Health & Social Care

Important information: This guide provides general operational and employment-practice guidance for care providers in England. It is not legal advice. Providers should follow current ACAS guidance, relevant employment legislation, CQC requirements and their own HR policies, obtaining specialist advice where appropriate. Interim appointments must also comply with applicable CQC registration and notification requirements.

Frequently Asked Questions: Managing an Underperforming Care Home Manager

1. What should I do if my Care Home Manager is underperforming?

The first step is to establish exactly where performance is falling below expectations and whether this is affecting the quality or safety of care.

Review relevant evidence, including CQC findings, internal audits, safeguarding concerns, staffing levels, complaints and financial performance.

Arrange a meeting with the manager to discuss the concerns, understand any underlying issues and agree clear expectations for improvement.

Where appropriate, introduce a structured performance improvement plan with measurable objectives, regular reviews and appropriate support.

If the concerns are serious or performance does not improve, formal capability procedures may be necessary.

2. Can I dismiss a Care Home Manager for poor performance?

Yes, poor performance or lack of capability can potentially provide a fair reason for dismissal, provided the employer follows a fair and lawful process.

This will usually involve identifying the concerns, providing appropriate support, allowing a reasonable opportunity to improve and following the organisation's capability procedures.

Employers should also consider relevant circumstances, including disability-related adjustments and alternatives to dismissal.

Dismissal should not be treated as an automatic first response, and specialist HR or employment-law advice may be appropriate.

3. How long should a Care Home Manager be given to improve their performance?

There is no single fixed period that applies to every situation.

The timescale should reflect the seriousness of the concerns, the improvements required and the support available.

Some operational issues may require immediate corrective action, particularly where resident safety is involved. Other performance concerns may reasonably require several weeks or longer to demonstrate sustained improvement.

A performance improvement plan should include clear targets, realistic deadlines and regular review meetings.

4. What are the warning signs of a poorly managed care home?

Common warning signs include high staff turnover, increasing agency costs, repeated medication errors, unresolved safeguarding concerns, poor audit outcomes, declining occupancy and complaints from residents or relatives.

Other indicators may include weak communication, low staff morale, inconsistent supervision and a failure to complete agreed improvement actions.

These issues do not necessarily mean the Home Manager is solely responsible, but they should prompt a closer review of the home's leadership and operational performance.

5. Can poor management affect a care home's CQC rating?

Yes. Ineffective leadership can contribute to concerns about whether a care home is safe, effective, caring, responsive and well-led.

Weak governance, unresolved risks, poor staff supervision and a failure to act on quality concerns may all influence CQC assessment findings.

However, an underperforming manager does not automatically result in a lower rating. The regulator considers evidence about the quality and safety of the service more broadly.

Providers should address emerging leadership concerns before they develop into wider compliance problems.

6. What happens if a Care Home Manager resigns or is dismissed?

The provider must ensure that appropriate leadership, oversight and regulatory arrangements remain in place.

This includes confirming who is responsible for day-to-day management, maintaining safe staffing arrangements and meeting any applicable CQC registration and notification requirements.

An experienced Interim Care Home Manager can provide continuity while the organisation recruits a permanent replacement.

This can be particularly valuable where the service is already experiencing quality, staffing or operational difficulties.

7. Can I bring in an Interim Home Manager while dealing with an underperforming manager?

Yes. Depending on the circumstances, an interim professional may provide additional operational support, oversee specific improvement priorities or take on an appropriate temporary management role.

However, the provider must carefully consider the existing manager's employment rights, contractual responsibilities and any ongoing capability or disciplinary procedures.

An interim appointment should not be used to predetermine the outcome of a fair employment process.

Where appropriate, interim leadership can help maintain continuity and strengthen oversight while the provider addresses its management challenges.

8. How quickly can an Interim Care Home Manager start?

An experienced Interim Care Home Manager may be available to mobilise within days, depending on their availability, location, the requirements of the assignment and any necessary compliance or regulatory arrangements.

Leaders in Care works with experienced interim care professionals and can help providers identify suitable candidates for urgent management cover, service stabilisation and turnaround assignments.

9. Can an Interim Home Manager help improve a care home's CQC rating?

An experienced Interim Home Manager can support the improvements that may contribute to better CQC assessment outcomes.

This could include strengthening governance, addressing outstanding regulatory actions, improving safeguarding oversight, supporting staff development and introducing more effective quality monitoring.

However, no interim manager can guarantee a particular CQC rating. The focus should be on achieving meaningful, sustainable improvements in the quality and safety of care.

10. Is it better to appoint an Interim Home Manager or recruit a permanent replacement?

This depends on the circumstances of the home.

Where a service is stable and there is sufficient time to recruit, a permanent appointment may be the most appropriate option.

However, if a home is experiencing significant management difficulties, regulatory concerns or an unexpected leadership vacancy, an interim appointment can provide immediate support.

It also gives the provider time to identify the right permanent leader without compromising on experience or suitability because of recruitment pressures.

11. How much does an Interim Care Home Manager cost?

The cost of an Interim Care Home Manager varies depending on the individual's experience, location, the complexity of the service and the responsibilities involved.

Specialist turnaround assignments or services requiring significant regulatory improvement may command higher day rates than straightforward management cover.

Providers should also consider the wider financial implications of leaving a struggling home without effective leadership, including agency expenditure, staff turnover, occupancy and operational performance.

Leaders in Care can discuss the requirements of an assignment and provide guidance on suitable interim options and associated costs.

12. How can Leaders in Care help with an underperforming Care Home Manager?

Leaders in Care supports care providers with experienced interim leadership during periods of management difficulty, service improvement and operational change.

Whether a provider needs temporary management cover, additional leadership capacity or an experienced professional to support a care home turnaround, we can help identify individuals with relevant experience.

Our approach is to understand the challenges facing the home and match the provider with an interim professional who has the skills and experience required to make a meaningful difference.

If you're concerned about management performance in one of your care homes, contact Leaders in Care for a confidential discussion about how interim leadership could support your service.