Pensioner, 91, died after care worker was too frightened to help him
A 91-year-old man who died at a care home after becoming wedged in a section of his bed was ignored because a carer was too frightened to help him, an inquest has heard.
Paul Batchelor called out for over an hour after getting stuck late at night at The Red House care home in Ashtead, Surrey, on June 28 2023.
When the on-duty carer heard him crying out, she did not open the door or go into his room as she was “frightened” and his cries stopped ten minutes later, the hearing was told.
Susan Ridge, the assistant coroner for Surrey, has since called for better training of care home staff.
The bed Batchelor slept on had a mattress extension fitted at the foot end, which had fallen through the bed frame onto the floor when he manoeuvred himself on top of it, the inquest heard.
The coroner said the bed was supposed to have a deck in place to prevent such falls but that the care home was unaware of this, meaning the bed had been without this support for years.
The inquest heard Batchelor was assisted to bed at 9pm by members of staff before crying for help at 10.05pm and continuing to shout until 11.15pm.
‘She was frightened of him’
In a prevention of future deaths report, Ms Ridge said: “Mr Batchelor slept in an extended profile bed which utilised a mattress extension to cover the gap between the standard mattress and the footboard.
“His bed was also fitted with bed rails. Later that same night he manoeuvred himself across the foot end of his bed, lying on the mattress extension.
“The bed did not have a deck in place supporting the mattress extension. As a result, the mattress extension fell through the bed extension frame and Mr Batchelor became wedged in the gap which was then created between the standard mattress and the foot board.”
“For much of this time, staff were undertaking their night-time routine,” Ms Ridge said.
“However, the evidence revealed that a carer heard his cries at [11.05pm] that night, but she did not open the door or go into his room as it was said she was frightened of him.”
Batchelor was found dead in the approximately 20cm gap shortly before 11.30pm.
Care home’s lack of awareness concerning
The coroner recorded a narrative verdict that Batchelor died of an accident contributed to by neglect, with the medical causes being “positional asphyxia” and pneumonia.
The care home has briefed staff since this incident on the need to check on residents by going into their rooms, Ms Ridge was told, but has not explained to staff what they “should do if they are frightened or concerned about entering a room on their own”.
She said: “There is the risk that – rather than disturb a resident – care home staff through, for example, fear or lack of time, do not check a resident who may be in distress.”
Ms Ridge was also concerned by the care home’s lack of awareness of the need to have a support in place on this type of bed.
Her report has been sent to the Red House Care Home, the Care Quality Commission and Medicines and the Healthcare Products Regulatory Agency. They have 56 days to respond.