Care home staff have told the OceanNewsUK they feel exploited and trapped by the firm that brought them to the UK to work.
Employees at Prestwick Care told an undercover Panorama reporter they believed their contracts prevented them from leaving.
The OceanNewsUK investigation also saw low staffing levels which health professionals said put vulnerable residents at risk.
Prestwick Care denies any suggestion of systematic wrongdoing or bad practice.
An undercover reporter for Panorama took a job as a care assistant at Addison Court in Crawcrook, to the west of Gateshead - one of 15 care homes in the north-east of England owned by Prestwick Care. He worked there from September to November this year, after hearing allegations from local health professionals about conditions in the home.
Addison Court is home to more than 50 elderly people, with weekly fees averaging about £1,100. These are paid for either by the local authority, the NHS, the residents or their families.
Like many care homes in the UK, Addison Court relies heavily on workers from overseas.
In the year to September 2023, 140,000 visas were issued for overseas health and care workers to come to the UK - more than double the previous year. Of these, 39,000 were issued to people from India.
Nurses and care workers from overseas are eligible for a skilled worker visa. This means that they can work in the UK, but they need to be sponsored by an employer.
If they leave their job, they have 60 days to find another suitable post - otherwise they have to return to their home country.
Concerns have been raised about the power this gives employers.
"If you are in a position of power as a boss, then you can exert coercive control over an individual," says Andrew Wallis of the anti-exploitation charity Unseen.
Prestwick Care employs about 180 overseas workers who are in the UK on visas - nearly a third of its staff base.
One Indian nurse there told the reporter that she was unhappy in her job, but felt she could not quit, because her visa was sponsored by the company, and she believed she had no choice.
"I can't get out of here. If I was back at home I could at least resign. But here, I can't just walk away," she explained.
Prestwick does not make life easy for those overseas nurses who have chosen to quit the company.
Ahmed (not his real name), came to the UK from the southern Indian state of Kerala in 2018.
When he arrived, he was asked to sign a contract. It said that if he left the company within five years, he would have to pay Prestwick Care more than £4,000, which included the money the company had already paid to the Home Office, and the legal fees for his visa.
According to the Department of Health and Social Care (DHSC) Code of Conduct, staff should not have to pay these costs.
Ahmed says he was told: "If you don't want to stay here on that contract, you can go back to India."
He says he felt Prestwick Care was trying to prevent him leaving, but he nevertheless resigned after being offered a more senior role at a care home run by another company.
Prestwick Care then started legal action against Ahmed, claiming that he owed the company more than £5,000.
He then called Bunty Malhotra, CEO of the Malhotra Group, which owns Prestwick Care. He told Ahmed, "What you have done is immoral, unethical and terrible."
Ahmed was also told a clause in his contract stopped him from working for any competitor care home for six months.
Liana Wood is a solicitor. She says that this clause would not be upheld by a court or a tribunal, and says that it was simply there "to serve a purpose of making [nurses and senior care assistants] trapped in their situation".
The legal action against Ahmed was eventually settled by his new employer.
Andrew Wallis of Unseen says that loading workers with debt is used as a means to control by unscrupulous bosses.
Prestwick Care denies that its contracts are designed to intimidate its employees and says it is now reviewing repayment clauses in all staff contracts.
For some of the staff at Addison Court, the situation was made worse by the fact that they had also paid between £6,000 and £10,000 for their visas through a recruitment agency called BGM Consulting.
A three-year visa would only have cost £551 if they had applied directly through the UK government website.
The DHSC says that companies should not work with recruitment agents that charge job seekers a fee.
BGM's director, Sunil Thomas, says the company has not taken any funds towards the recruitment of care workers in the UK, and claims that any money paid would have been to "sub-agents" acting without his knowledge in India.
Prestwick Care says it has now suspended all new arrangements with BGM Consultancy.
The reporter also heard concerns about how low staffing was affecting the standard of care at Addison Court.
There are no rules on how many staff a care home should employ. Prestwick Care says that on night shifts (between 20:00 and 08:00), one nurse can provide ample care for 54 residents, as they are supported by a team of carers, some of whom can administer medication.
However, an agency nurse who covered the night shift told the reporter that this was difficult to manage, and that some residents were not always receiving their medicines on time.
Administering drugs late can have serious consequences for some conditions, for instance, insulin injections for diabetics, or medicines for Parkinson's disease.
The agency nurse says he once tried to raise concerns about staffing levels with Bunty Malhotra. He says Mr Malhotra swore at him and was dismissive in his response - a claim Mr Malhotra denies.
Other staff at Addison Court also told the undercover reporter that concerns had been raised about the lack of staffing, but that the management were not interested.
The workers' concerns have been echoed by local health professionals.
A GP with patients at Addison Court, who asked to remain anonymous, told Panorama she saw a trend with certain patients not getting their medication on time.
She said that staff recognised that care was not always adequate, but they felt there was no point bringing their concerns to the management, because they would "either somehow make it their fault or just try and sweep it under the carpet".
The manager of Addison Court says that it is completely untrue that she fails to investigate complaints, and says she has positive relationships with staff at the home.
Care Workers Under Pressure
Panorama investigates a care home short of staff, where external medical professionals report seeing residents neglected, and overseas staff complain of being exploited.
NHS nurse Katy Maughan visited the home once a week until last year. She says the nurses she spoke to were unhappy, but felt they couldn't leave.
She thought staff were not escalating concerns because they did not want to upset the company and have to leave the country.
Ms Maughan says she was so worried about some residents that she made 33 safeguarding alerts over a two-year period to the local authority, Gateshead Council.
One of those alerts was about a resident who she says died after being left for 72 hours with severe constipation. She believes the death was preventable.
"They [the staff] should be speaking to the GP and saying, look, we still haven't had a bowel motion, and they should be getting medical advice. It's neglect."
Gateshead Council told Panorama it was unable to share the outcomes of the safeguarding concerns because it would involve releasing highly sensitive personal information. It says each alert was responded to and "managed in the best interests of the residents… based on the evidence provided at the time".
In its latest published accounts, Prestwick Care's parent company, Malhotra Care Homes Limited, made a profit of £9.3m in in the financial year 2021-22. Chartered accountant Vivek Kotecha says this margin - about 40% - is very high for a care home. He thinks that an explanation for this may be that the company is spending less than its competitors on staff.
"That's kind of worrying," he says, "because these kinds of patients need staff and care… otherwise they are at risk of falls or injuries."
In December 2022, Prestwick Care had its licence to sponsor overseas staff suspended by the Home Office. No reason has been given for the action.
Following the news, Bunty Malhotra called Addison Court's Indian staff to attend a meeting, where he tried to persuade them to stay.
He implied that he was willing to overlook and cover up any mistakes they made.
"If you work for the NHS, one mistake [and you will be] reported to the NMC (Nursing and Midwifery Council) straight away," he is recorded saying.
"We will always protect our staff, we'll always say, 'this mistake is a training issue'... this protection isn't allowed outside."
Seeing the footage of the meeting, Katy Maughan said she was shocked at how he appeared to be trying to scare staff into staying at the care home.
The Home Office has now "fully revoked" Prestwick Care's licence to sponsor overseas staff. Following the safeguarding reports, including from the OceanNewsUK, the regulator, the Care Quality Commission (CQC), has suspended Addison Court's "good" rating.
In a statement to the OceanNewsUK, the CQC said that it was "closely monitoring Addison Court along with the other locations registered to this provider". It added that if there were immediate concerns about people's safety, "we will use our enforcement powers to keep people safe".
Prestwick Care says any suggestion that there has been systematic wrongdoing or bad practice, is unfair and inaccurate. It says that the safety and wellbeing of staff remains paramount, and that it is "fully committed to thoroughly investigating all concerns raised, and taking appropriate actions as necessary".
