Evelyn Burcham
31 Jan 2023 · Coroner Samantha Marsh · Somerset
The coroner's concerns
1. residents accessing chair controls
“I am concerned that these chairs are common place in care home settings where residents suffer from cognitive impairment. The risks of another resident with dementia accessing the controls of the riser-recliner chair(s) was not foreseen by the Home and so was not factored into any operative risk assessment at the time; hence no measures were in place to minimise the risk. There remains a real and immediate risk that those with a cognitive impairment that manifests itself in a compulsion to fiddle”
Responses
2023-0421-Response-from-Aria-Care.pdf ↗· Care Quality Commission
Stated action · 56 days
“Following receipt of the request, Aria Care reached out to Shackleton's, our furniture supply partner seeking advice and guidance on riser/recliner chairs and the potential for purchase and supply of handsets that could be locked in a secure position and avoid unauthorised access and repositioning.”
2023-0421-Response-from-Department-of-Health-and-Social-Care-1.pdf ↗· Department of Health and Social Care
2023-0421-Response-from-Department-of-Health-and-Social-Care.pdf ↗· Department of Health and Social Care
2023-0421-Response-from-Health-and-Safety-Executives.pdf ↗· Health and Safety Executive
Stated action
“HSE contacted the other regulatory bodies who may have an interest or potential regulatory role in respect of this incident. We have written to CQC (who are already in receipt of your report) on the patient safety aspects. HSE has also notified the Office for Product Safety and Standards (OPSS) who are the national regulator for consumer products and who work with the local authority Trading Standards services that undertake most enforcement activity.”