Coroner criticises care home near Doncaster after death of resident
A care home has been criticised after the death of a woman who is thought to have suffered a number of falls at the site.
Elsie Elliott died on March 12 at Rotherham Hospital after suffering a fall at the Layden Court Care Home, on All Hallows Drive, Maltby.
The 87-year-old had suffered a subdural haematoma – a serious condition where blood collects between the skull and the surface of the brain.
But the assistant coroner criticised the standard of record keeping kept by the care home which left her unable to paint a clear picture of what had led to the death.
An inquest at Doncaster Coroner’s Court recorded a verdict that widow Mrs Elliott died as a result of an accident.
But Doncaster assistant coroner Louise Slater said Mrs Elliott had suffered injuries in a series of falls in March.
She said: “Despite my best efforts there are inconsistencies to evidence that exist between different witnesses, between Mrs Elliott's friends and family and the care home, and also with record keeping, so although the standard of proof is lower than a criminal court, it has not been possible to determine exactly if there was one fall responsible for the subdural haematoma or a combination of two or more falls, because of inconsistencies.
“She fell on March 7 first and was known to have a red mark on her cheek. She might have hit her head.
“It is not helpful or acceptable to speculate. The evidence is just not enough to determine if there was a single event. Inquiries identified examples of poor record keeping, lack of report files, and training deficiencies in staff and failings in the manager, all deficiencies which have hindered this investigation, and played a part in not being able to determine the exact number of falls and how they contributed to Mrs Elliott's death.
“I don’t think there are any further measures we can take to make matters clear, and I don’t think the exact nature of which fall caused her death can be determined."
She said she had considered whether to issue a regulation 22 prevention of future deaths report, but was content lessons had been learned by the home and accepted that the home had taken the issue seriously.
She added the home was subject to external scrutiny, and it would be a matter for the Care Quality Commission and others to keep it under review.
“If similar matters come before the court I would expect the information to me more detailed and improved,” she added.
Four Seasons Health Care, which runs the home, said in a statement: “We are fully aware of the comments made at the inquest and, as recognised by the Coroner, have taken swift and significant measures to make improvements at the home.”