A report published today outlines a string of damning incidents at a care home for vulnerable adults.

A number of safeguarding improvements have been recommended by Dorset Safeguarding Adults Board (DSAB) following an investigation into Purbeck Care Home in East Stoke.

The Serious Case Audit (SCA) into the now closed home found that residents suffered abuse and received inadequate standards of care between January 2010 and November 2012.

The report highlights a number of learning points for health and social care agencies, including better sharing of information, stronger links with families and advocacy services as well as improved procedures for staff to raise concerns about standards of care.

The investigation began in 2012, when the home had 40 residents placed by various agencies from across the country. A newly appointed member of staff raised concerns after finding verbal abuse as well as neglect of one of the vulnerable residents with learning disabilities.

He also reported that some residents were left on their own all day despite having a history of self-harming. As well as reports of neglect and abuse, there were also concerns about the dirty condition of the home and lack of staff on night-time duty.

Dorset County Council stopped funding any new placements in 2012, following an incident where a male member of staff subjected a female resident to a prolonged period of physical and verbal abuse. He was sentenced to six months imprisonment in 2013.

A subsequent multi-agency case audit uncovered significant gaps in staff training, lack of planning sufficiently for care of older residents, limited access to any activities and poor provision of food and beverages.

The report prompted the council to find suitable alternative accommodation for the residents, and the number of placements at the home dropped to 23. The home eventually closed in October 2014.

The SCA highlights a number of failings to ensure the privately owned and run home was adequately operated. It also calls for action on all health and social care organisations involved to improve communication, cooperation and sharing local intelligence.

The most significant point in the report underlines the view that vulnerable people with complex needs should be cared for in local communities, or care home placements close to their home and family where they can receive better care and support, to prevent institutionalised neglect and abuse in the future.

All agencies involved, including local councils, the police and Care Quality Commission, have welcomed the recommendations of the report and are keen to work closely to reduce the risk of similar mistakes being made in the future.

Jane Ashman, chair of the DSAB, said: “This in-depth review is about the lessons we must learn and the actions we must take to prevent abuse from happening again.

“It is also about promoting a culture and a way of working that actively challenges poor practice and promotes compassionate care across the system.

“Accommodation and support services for people with a learning disability have developed greatly over the past decade to meet changing needs and expectations. Most adults with a learning disability and their carers prefer more independent living where people have their own self-contained accommodation and yet can maintain contact with others such as friends.”