Residents with dementia at a north Norfolk care home were at risk of leaving the home without supervision, a report has found.
Ingham Old Hall, in Sea Palling, was rated inadequate for a second time, leaving it in special measures.
The Care and Quality Commission (CQC) report said inspectors observed how an external door had been left open with no staff present for more than 10 minutes.
Inspectors made an unexpected visit to the home, which provides support for up to 25 people aged 65 and over, in March.
A spokesperson from Ingham Old Hall said: "In our opinion we had made significant improvements since our previous inspection in June 2018. We did challenge some inaccuracies but these were not deemed sufficient to alter the rating."
The CQC said care records were not updated after incidents and accidents, residents were at risk of choking, and a person who fell down steps had been wearing ill-fitting shoes.
The report also said: "We identified exposed hot pipes and radiators, they did not offer full protection from risk of burns and scalds.
"We observed an external door to be left open with no staff present for over 10 minutes, increasing risk of residents leaving the building without staff being aware."
A care home spokesman said the CQC had wanted to remove their registration but after appealing they had been allowed to stay open. He said: "We continue to stand by our belief that the report was not fair, balanced or proportionate. We are confident that we have made the necessary improvements to evidence our compliance and we are looking forward to a more positive outcome from our next CQC inspection."
Inspectors also found examples where medical advice was not being followed by staff, and medication record sheets were being signed retrospectively. The staff office was found unlocked, meaning there was access to care records, and inspectors "overhead staff discussing a person's medical status in the dining room when other people were present".
Some improvements had been made, and staff were treating people with more dignity and respect. But inspectors found: "There were ongoing and significant shortfalls in service leadership."
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