A frail pensioner who fell into a gap beside his bed died when his cries for help were ignored by a carer who was “frightened” of him, an inquest heard.
Paul Batchelor, 91, became wedged next to his bed in the middle of the night. However when the duty carer heard his calls for help she did not open the door to his room at the Red House Care Home in Ashtead, Surrey, and his cries stopped 10 minutes later.
Mr Bachelor was found dead in the gap next to his bed the next day. In a Prevention of Future Deaths report, assistant coroner for Surrey, Susan Ridge said: "For much of this time staff were undertaking their night time routine.
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"However, the evidence revealed 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. 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 bedrails. Later the 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 footboard. 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."
The inquest heard Mr Batchelor was assisted to bed at 9pm by care home staff and called for help at 11pm. He was found dead in the approximately 20cm gap shortly before 11.30pm.
Assistant Coroner for Surrey Susan Ridge has now called for better training for care home staff and recorded a narrative verdict saying Mr Batchelor died of an accident contributed to by neglect with the medical causes being 'positional asphyxia' and pneumonia.
Ms Ridge heard how since this incident, the care home had briefed staff about the need to check on residents by going into their rooms - but it had not explained to staff what they 'should do if they are frightened or concerned about entering a room on their own'.
