A care home could be shut down after an unannounced inspection found one resident left with food on their face and another who almost choked on meat.
The Care Quality Commission (CQC) sent inspectors in to assess Sandgate Manor near Folkestone in June after concerns were raised over the management of the service, its staffing levels and the support for vulnerable clients.
At the time of the inspection there were 21 people being cared for at the two-storey home in Military Road, which offers residential care for people who may be living with a learning disability or autistic people.
Inspectors uncovered a catalogue of problems at the home and their report brands it inadequate across five areas of assessment: is the service safe, effective, caring, responsive and well-led?
Hazel Robson, CQC head of inspection for adult social care, said: "During our inspection of Sandgate Manor there were widespread and significant shortfalls in the leadership of the service.
"Staff weren't clear about their roles and responsibilities in relation to the overall quality of care delivered.
"One person was left for some time with food on their face before staff supported them to clean it off.
"They were eating in the entrance hall by the door so they would be on full view to anyone visiting the service.
"There were some cases where staff were treating people in a demeaning manner. Our inspectors saw one person being made to say please before being provided with assistance to eat and then being called a 'good girl' when they did. This isn't a respectful way to treat anyone."
As a result of the inspection the overall rating for the service has fallen from 'good' to 'inadequate' and the home has been placed in special measures.
It will be kept under review by CQC and re-inspected to check sufficient improvements have been made. If they are not then there is the chance it could be shut down.
During the visit, inspectors identified one person having a near-miss choking on some meat.
"They had historical swallowing issues which had improved following medical intervention," according to the CQC.
"Following the incident, no action had been taken to assess if the person's choking risks had increased to reduce the risk of the person choking again."
The inspectors found one resident had an "unexplained graze".
"This was reported as an incident but there was no investigation in to how it occurred, and it wasn’t reported to safeguarding," they added.
"One person was recorded as having hit another person. There was no information on what action was taken to reduce re-occurrence or any record that it was reported to safeguarding."
The CQC team also highlighted how one resident's care plan stated they were overweight and at risk of serious health issues - so had been recommended a low sugar, low carbohydrate diet.
But the inspectors "saw staff encourage the person to eat sugary food".
Responding to the report's findings, a spokesman for Sandgate Manor said: "We welcome many of the comments and suggestions raised in the report and have already made numerous improvements including strengthening of the management team.
"We are however advised that the rating given does not reflect the true nature of the home and we have initiated an appeal.
"Sandgate Manor has a long and successful legacy which we intend to uphold and continue, and we are grateful for all the support we are receiving at this time."