A CARE home has apologised to the family of a pensioner who died after spending a freezing night outside because staff failed to follow the right procedures.
The jury at the four-day inquest into Dorothy Spicer’s death returned a narrative verdict at Stamford Town Hall on Friday, which said the 84-year-old died of pneumonia due to decreased mobility following a bout of hypothermia and dementia.
Mrs Spicer, who previously lived with her daughter in Market Deeping, was found lying in the grounds of Whitefriars Care Home in St George’s Avenue, Stamford, at 5am on November 26, 2009. She was outside in freezing conditions for more than eight hours.
Paramedics were called to the home at 6.42am and she was admitted to hospital. She died on January 21, 2010.
A jury statement: “The afternoon shift and the night shift did not follow the right procedures. There were no forms filled out at handover and there was no head count.”
Earlier in the week Mrs Spicer’s daughter Jane Howard gave evidence of how her mother’s health deteriorated after that night.
After the verdict, Mr Ryall said: “To Mrs Spicer’s family the death of their mother in such circumstances has been a great source of sadness. They will never forget that for about eight hours their mother was outside in the cold.
“I have no doubt members of staff have been affected by her death. There were systems in place that would have prevented this incident but they were not followed.
Speaking after the hearing, Mrs Howard said: “There are many unanswered questions but now as a family we have to draw a close.
“After almost two and a half years of torment and nightmares we have got to bring it to an end. And what an end. We have won.
“The total malfunction of that home is unbelievable. We haven’t thought our next steps yet.”
A spokesman for the Orders of St John Care Trust, which runs the home, said: “We are grateful to the coroner for his thorough examination of the evidence and have taken careful note of his comments.
“The trust has always accepted that it let Mrs Spicer and her family down, for which it is sincerely and deeply sorry.”
During the inquest the jury heard the last time Mrs Spicer was last seen alive was at about 8.30pm on November 25, when she was sitting in a lounge.
At 8.52pm the alarm on a door in a neighbouring lounge was activated and carer Louise Baldwin went to check it. The door was closed but Mrs Baldwin went outside to see if anyone was there.
She did not search the place where Mrs Spicer was eventually found. She went back in and reset the alarm and told no-one of the incident.
Summing up, Mr Ryall said that if the correct procedure had been followed the incident would have been reported to the care leader who would have started a headcount.
Later that evening a male resident got outside and was found and returned to the home. Mr Ryall said a head count should have been carried out then but was not.
The firm that installed the home’s door alarm system inspected it on January 26, 2010, and found a door in the lounge where Mrs Spicer liked to sit was disarmed at the time she was last seen.