Devon care home fined over £60,000

They failed to provide safe care to resident

A Devon care service has been ordered to pay £62,304.30 after failing to provide safe care and treatment to resident, Robin Lee, in a prosecution brought by the Care Quality Commission.    

Ashburton House Care Home Limited, from Newton Abbot, pleaded guilty to failing to provide safe care and treatment to Mr Lee, which exposed him to a significant risk of avoidable harm, according to Plymouth Magistrates' Court. 

This is an offence under Section 22(2)(b) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014   

The court fined Ashburton House Care Home Limited £48,000 for this. It was also ordered to pay a £190 victim surcharge and £14,150.30 costs. 

Mr Robin Lee, was admitted to Ashburton House Care Home on January 10 2022. He was diagnosed as living with dementia but was mobile and able to walk around. However, he had been identified as high risk for falls, having experienced numerous falls during his time at Ashburton House. Despite his room being on the ground floor, he regularly used the stairs and entered other residents’ bedrooms unaccompanied.

On May 23 2022, Mr Lee entered an upstairs bedroom occupied by another resident and fell down some steps in that bedroom. At the time, only two staff members were on duty. When staff discovered him at the bottom of the steps, he was unresponsive and had sustained serious injuries consistent with a fall.

A post-mortem examination determined Mr Lee’s cause of death as bleeding on the brain through a traumatic injury, a fall downstairs in the care home, dementia, glaucoma (registered blind).

Ashburton House records show that previously, staff found Mr. Lee upstairs at least twice. While staff had identified the need to house Mr. Lee on the ground floor, the risk assessments failed to adequately consider his access to the stairs or how to manage that risk. Mr. Lee used a zimmer frame, further increasing the importance of assessing stair-related risks.

CQC brought the prosecution as it believed that if Ashburton House Care Home Limited had complied with their statutory obligations, Mr Lee would not have been exposed to such a significant risk of harm.  

Cath Campbell, CQC deputy director of operations in the south said:  “Our sympathies are with the family and friends of Mr Lee following his potentially preventable death. 

“People receiving care and treatment have the right to expect that any risks to their safety are effectively managed   

“The failure of Ashburton House to manage risks and follow essential guidance to manage risk to Mr Lee’s safety and wellbeing was unacceptable.

“The majority of care homes do an excellent job. However, when a home puts people in its care at risk of harm, we will take action to hold them to account and to protect people.  

“This fine is not representative of the value of his life, but I hope this prosecution acts as a reminder to all care homes of their duty to assess and manage all risks to ensure people are kept safe and families and loved ones are kept informed.”