THE death of a resident at a former Highland care home has seen the company that owned it fined almost £2 million.

A 96-year-old choked to death at Cradlehall Care Home in Inverness on June 11, 2022 and this week HC-One Ltd - a Darlington-based organisation - admitted insufficient care and supervision with regard to what was the fifth death in their Scottish establishments in the last six years.

At Inverness Sheriff Court today fiscal depute David Glancy told the court that Mrs Margaret -- Peggy -- Campbell had been transferred to the home from Raigmore Hospital in 2019 with clear instructions for eating and supervision due to her choke risk.

Despite this she was left unattended for 20 minutes - contrary to her care plan - while she was eating her supper of macaroni and chips.

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Sheriff Robert Frazer was told that although the food had been properly prepared in small chunks for her, she still choked.

He attached no blame to the 18 year old carer and two agency workers who had been left in charge of the home's Cawdor Unit where Mrs Campbell was accommodated, after a senior staff member had unexpectedly gone home ill.

He also noted that the employees had also been distracted by other residents who required assistance, preventing the teenager from returning to Mrs Campbell's room sooner.

At the court today, he said: "The offence is very serious given that a resident died, the home were responsible for her care. There was a clear and unambiguous plan in place to supervise and oversee her eating of the food that was prepared for her."

He placed the level of harm by the company's health and safety failings at the highest, but accepted it was not a deliberate act or "a flagrant disregard of the law."

Sheriff Frazer also placed their culpability level at medium and extended the court's sympathies to Mrs Campbell's surviving family.

HC-One Ltd - which operates 190 properties - was fined £1,935,000.

Defending the firm Peter Gray KC said the company had at the time experienced a staffing crisis largely due to Covid and offered his client's "deepest sympathies."

He added that all civil claims had been settled quickly.

Mr Gray said that 20 months prior to this tragedy the home had been been given a "good report" by the Care Quality Commission (CC) but subsequently "the failings were due to significant staffing challenges and by June, 2022 the staffing situation had deteriorated with four Covid outbreaks at the home."

He said: "There was a thorough examination afterwards with a series of measures taken."

Another CQC inspection in April 2023 was positive, he said.

The home was subsequently acquired by St Philips Care but closed last April after inspectors raised serious concerns about quality of care and plans were later approved to transform the site into retirement flats.

"The death shook the organisation to its core and it collaborated with other agencies to take innovative steps to establish best practice in care and training and ensure there is no repetition," he said. "It is set to be an industry standard."

Sheriff Frazer decided on a headline sentence of a £2.5million fine but reduced it for the company's early plea and other legal factors.

He concluded: "My real concern is the record of previous convictions.

"Account must be taken of the fact that the company has four previous convictions in Scotland within the last six years for directly analogous offences, all of which have been dealt with by fines ranging from £200,000 to just over £800,000."

Speaking after sentencing, Debbie Carroll, who leads on health and safety investigations for the Crown Office and Procurator Fiscal Service, said: "The death of this vulnerable woman could have been prevented if a safe system of work were in place to ensure that on any occasion she ate a meal, she was subject to an appropriate level of supervision.

"HC-One Limited's failure left all residents at risk. This prosecution should reiterate the need for all care homes to protect their residents and remind them they will be held accountable if they fail to do so.

"Our thoughts are with the family of the resident at what must be a difficult time for them."