A care provider has been fined £1.5m at Crawley Magistrates’ Court, after it failed to meet a resident’s nutritional and hydration needs and protect them from avoidable harm.
Care UK Community Partnerships Limited was also ordered to pay a £170 victim surcharge and £27,000 costs to the Care Quality Commission (CQC) which brought the prosecution.
Care UK Community Partnerships operates a number of care homes in England, including Mill View in East Grinstead. Mill View is a care home providing accommodation with personal and nursing care for up to 70 people.
The background to the case was that in April 2018, an 86-year-old male resident (MC) was admitted to Mill View after being discharged from East Surrey Hospital. While at the hospital, he was referred to a speech and language therapist (SALT) who advised he was at risk of choking and needed a special diet of soft foods.
On 30 April 2018 a choking risk assessment was carried out by a Care UK team leader. This did not identify any choking risks.
On 16 May 2018, a Care UK regional nurse reviewed MC’s care plans and amended the eating and drinking plan to state that he “eats a normal diet and drinks normal fluids”. A choking risk assessment was completed and, again, no choking risks were identified, the CQC said.
Four days later, on 20 May, the resident was having lunch at the dining room table, when he started to choke and became unresponsive. A post-mortem found he had eaten large pieces of meat and concluded the cause of death was choking on food.
The CQC said it was found that staff did not understand how to prepare the correct diet or to safely support the resident to eat and drink. “The service also failed to maintain accurate care records and the advice of the SALT was not fully incorporated into the resident’s care plans and risk assessments. He was therefore given unsafe and inappropriate foods from the time of his admission until his death.”
The company pleaded guilty to failing to provide safe care and treatment to MC, resulting in him being exposed to significant risk of harm which ultimately led to his death, the watchdog said.
Hazel Roberts, CQC head of inspection for adult social care, said: “Our sympathies are with MC’s family following his tragically needless death. He had the right to expect to be kept safe while living in Mill View and receiving care from the staff there, but in this case the provider, Care Community Partnerships Limited, failed in its legal duty to protect him from being exposed to significant harm.
“The majority of care providers do an excellent job. However, when a provider puts people in its care at risk of harm, we will take action to hold them to account and to protect people.
“I hope the outcome of this prosecution reminds care providers of their duty to assess and manage all risks to ensure people are kept safe”.
Care UK’s regional director Georgina Stocker offered the company's apologies and condolences to the family.
She said: "Following this incident in May 2018, we implemented a number of improvements across our homes to ensure we learn from this experience and minimise the chances of it happening again. These have included retraining everyone who might serve a meal, enhancing record keeping about people’s dietary requirements and scheduling different dining times, where needed, to give colleagues more time to support individual residents.
"This home was inspected by the Care Quality Commission in December last year and given a “good” rating. We now need to reflect on the conclusion of these legal proceedings and on how best to respond."