Care home manager ordered to pay £2,333 after resident exposed to risk of avoidable harm

A registered care home manager has been ordered to pay £2,333 after admitting failures in the care of a resident which exposed her to a significant risk of avoidable harm.

Suzanne Kirkbride, registered manager of Hall Lane Resource Centre in Manchester, pleaded guilty to an offence relating to the failure to provide safe care and treatment to Laura Margaret Donnelly.

The prosecution was brought by the Care Quality Commission (CQC) under Regulations 12(2) and 22(2) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The case centred on concerns about the management of Ms Donnelly’s diabetes, fluid and hydration needs and medicines. The CQC said staff at the service had not been appropriately trained to understand her condition and manage her complex needs, leaving her exposed to a significant risk of avoidable harm.

The court fined Kirkbride £1,666. She was also ordered to pay a £167 victim surcharge and £500 towards costs, bringing the total amount she was ordered to pay to £2,333.

Ms Donnelly has since died. The CQC expressed its sympathies to her family and others affected by her death but has not stated that the failures which formed the basis of the prosecution caused her death.

Rosalind Sanderson, CQC deputy director of enforcement, described the case as distressing and said Kirkbride had failed in her duty to protect Ms Donnelly by placing her in a service where staff were not trained to understand her condition or manage her complex needs.

Sanderson said the prosecution should serve as a reminder to care providers of their responsibility to protect people from avoidable harm and appropriately manage risks to their wellbeing.

She added that while the majority of adult social care services provide safe and effective care, the regulator would use its enforcement powers when it identified people being placed at risk.

Hall Lane Resource Centre, also known as Hall Lane Resource Centre Respite Care and Short Breaks Service, is operated by Manchester City Council and is registered to provide accommodation for people requiring personal care.

The service can accommodate a maximum of 10 people and supports adults with a range of needs, including learning disabilities, physical disabilities, dementia and sensory impairments. Its registration does not permit it to provide nursing care.

At its latest published CQC inspection, carried out in January 2024, Hall Lane Resource Centre was rated Requires Improvement overall. It was rated Requires Improvement for whether the service was Safe, Effective and Well-led, while Caring and Responsive were rated Good.

Inspectors at that time identified concerns including medicines management and staff training. The CQC found that medicines were not always managed safely and said staff had not always completed mandatory training or training relevant to people’s specific needs.

Regulation 12 requires registered providers and managers to ensure care and treatment are provided safely. This includes assessing risks to people’s health and safety and doing everything reasonably practicable to mitigate those risks, alongside ensuring medicines are managed safely and staff have the competence, skills and experience necessary to provide appropriate care.

The prosecution highlights the individual legal responsibilities that can accompany registered management within adult social care. While CQC enforcement frequently focuses on the organisation providing a regulated service, registered managers can also face action where the regulator believes their failures amount to a breach of regulations for which they are legally responsible.

The CQC said the financial penalty should not be interpreted as representing the value of Ms Donnelly’s life. Money from fines imposed by courts following CQC prosecutions is paid to HM Treasury rather than retained by the regulator.

For providers and registered managers, the case reinforces the importance of ensuring staff are properly trained to support people with complex health conditions and that care plans, medicines, hydration and condition-specific risks are understood and managed consistently.

When people depend on care services to manage conditions such as diabetes safely, those systems are not simply administrative requirements. Failures in training, medicines management or recognising changing health needs can expose people to serious and avoidable risks, which is why the CQC has the power to pursue criminal enforcement where regulatory requirements are breached.

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