A retired banker died after choking on a large piece of meat at a rundown care home which his family claimed was under staffed, an inquest has been told.
Geoffrey Burnand had choked two weeks before the incident which was to end his life – but no details of that had been written on his care plan which should have been done.
His daughter Ann Logan told the inquest in Exeter, Devon, that when her dementia sufferer father moved into Arcot House in Sidmouth, Devon, his condition 'suddenly deteriorated'.
She said:"He lost weight, he became more confused and unsteady on his feet and was more likely to fall."
She said the home, run by Guinness Care and Support, failed to meet his needs by 2012.
She said:"There were no enough staff. My stepmother was aware of the understaffing but it was the best place for him at the time."
She said sometimes the staff were not qualified or were agency staff.
She said after the first choking incident her father was not given urgent therapy, his meals were not chopped up into small pieces because of the problems he had swallowing and meal times were not supervised one on one.
The 84 year old's family also complained about the crumbling state of the Regency building, broken toilet, having to provide furniture for his room which was on the first floor. She accepted though that these problems did not cause his death.
The female manager at the time of his death had also been suspended, the coroner was told.
Mrs Logan said an interim manager said Mr Burnand had 'to stay in his room 24 hours a day' because the staff had difficulty getting him downstairs.
She saw him hours before he choked on his meal and said:"He was in very good form, cheerful and coherent. We had a couple of hours together and we had a good old chat about things."
His GP Dr Joanna Kinder said he suffered from advanced dementia and was at high risk of falling and spent some parts of a day 'crawling on the floor'.
The inquest heard claims that there was a high turnover of staff and a Care Quality Commission inspector said his care plan had not been updated for nine months.
The inspector said in October 2012 the home failed to meet certain standards after a relative tipped off the CQC about the staffing levels and cleanliness of the home.
And she said 'care plans were strewn on the office floor' but she said the 21 residents were being looked after by the registered manager, a senior carer and two junior carers – which she said met the standard for staffing.
She said warning notices were issued and the home did make immediate improvements including building works.
A consultant pathologist,, Dr Paul McCulloch, said Mr Burnand, from Carshalton, London, died the day after he choked on some food and suffered a heart attack which caused brain damage.
He said people with dementia and Alzheimers can be affected in their ability to swallow.
He said his cause of death was asphyxia contributed by aspirated food and the dementia.
The inquest, which may last all week, continues.
