Care Inspectors have warned the managers of an old people's home in Bathgate that it could face closure if urgent improvements are not made.
Inspectors visiting Meadowvale Care Home two weeks ago were alarmed to find residents with bed sores which had not been properly treated.
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Previous inspections by Scotland's care watchdog have also raised concerns about staffing, leadership and a lack of activities for vulnerable residents at the home.
The Care Inspectorate said it had issued a formal Improvement Notice on Meadowvale Care Home following an inspection which raised serious concerns.
The notice lists three areas which require urgent improvement to ensure residents "experience care and support that meets their needs and is right for them".
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The Inspectorate said they included consistent, good quality and effective management and leadership and making sure enough "qualified and competent" staff are on duty at all times.
The improvement notice adds: "In particular, where there is skin damage, appropriate care must be delivered to assist in wound healing to prevent residents suffering unnecessary distress."
A spokesperson for the Care Inspectorate said: “The Improvement Notice we have issued clearly lays out the improvements we must see so that the care experienced by residents improves quickly.
“We will visit this care home again soon to check on progress and if we are not satisfied that the matters raised are being addressed urgently, we will not hesitate to take further action.
“Everyone in Scotland has the right to safe, compassionate care which meets their needs and respects their rights."
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The notice warns that if changes are not made the Care Inspectorate would consider withdrawing Meadowvale's registration, forcing the home to close.
A spokeswoman for Four Seasons Healthcare, which operates Meadowvale, said: “We deeply regret that Meadowvale has fallen below the high standard that we expect and the Care Inspectorate requires.
"We would like to reassure the residents and their families that we take the situation extremely seriously and our priority is to continue to work closely with the Inspectorate and local authorities to appropriately address the issues raised.
"Our focus remains on the care and safety of our residents and we apologise to those affected.”
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