June 14, 2017
Minimising the Risk of Window-Related Deaths
Deaths in care homes are, to a certain extent, a natural occurrence, but those which aren’t leave serious questions to be answered and unfortunately require investigations.
In this blog we look at the most recent court cases and the issues which most commonly lead to fatal incidents in care homes.
Window fall led to resident’s death
In October 2013, an 87 year-old resident was reported missing and eventually found dead after falling four metres from her window.
The HSE investigation found the window restrictor, which normally prevents the window from opening fully, was easily overridden and therefore not fit for purpose.
Speaking after the hearing the HSE Inspector said:
“It was clear from our investigation that the window restrictor was simply not doing the job of preventing the window from opening. It is alarming, and tragic, that an 87-year-old woman with dementia was able to defeat it.”
“[The Care Home operators] therefore failed to ensure the woman’s safety, which is particularly important given its unique position of trust. All windows that are large enough for people [to fit] through should be restrained sufficiently to prevent such falls. The 100mm benchmark should only be allowed to disengage using a special tool or key.”
The resulting court case, which took place in June 2017 saw the care home operator fined £450,000 and ordered to pay costs of just under £15,000. The sentence followed a guilty plea for breaches of Section 3(1) of the Health and Safety at Work Act 1974.
Understanding the risks of falls from windows
A fall from a window is classed as a fall from height, which continues to be a major cause of deaths through H&S breaches accounting for a third of all deaths.
Since February this year prosecutions for this type of breach have resulted in fines totaling £600,000.
Health and Safety In Care Homes (HSG220) which was re-published in 2016 describes the basic controls which should be in place and the three categories of falls from windows:
1. Accidental falls
These can occur where a person is sitting on a window sill, leaning out of a window, or where the sill or banister height is low and acts as a pivot, allowing them to fall.
2. Falls arising from a confused mental state
Many reported accidents involve residents in either a temporary or permanent confused mental state, often caused by senility or dementia, reduced mental capacity, mental disorder, or alcohol and drugs (both prescribed and illegal).
In some cases, individuals try to escape from an environment they perceive to be hostile, and may use a window believing it to be an exit. Other factors may include unfamiliarity with new surroundings, uncomfortable temperatures, broken sleep and effects of medication.
3. Deliberate self-harm
This is a recognised risk for residents with certain mental health conditions.
Controlling the risks to care home residents
To adequately manage the risk of falls to residents, you need to assess the risks arising from the premises and any additional risks for individual residents.
Where residents are at risk, further measures may be needed to prevent them falling from height. Windows that can be fully opened and are accessible to people at risk of falling or climbing out must meet appropriate standards (as detailed below).
In assessing the risks, you should consider furniture, or other items, that may enable residents to climb over barriers or access windows which might otherwise be inaccessible.
Where necessary, you should provide adequate cooling such as high-level and/or restricted aperture ventilation, fans or air conditioning where window openings have been restricted.
Suitable controls may include window restrictors to stop vulnerable residents gaining access to window openings large enough to fall through, and at a height that could cause harm (e.g. above ground level).
Any such windows should be restrained sufficiently to prevent such falls.
Window restrictors should:
- Restrict the window opening to 100mm or less
- Be suitably robust to withstand foreseeable force applied by an individual determined to open the window further. Where the casement might distort, restrictors should be fitted at both sides of the window
- Be sufficiently robust to withstand damage (either deliberate or from general wear)
- Be robustly secured using tamper-proof fittings so they cannot be removed or disengaged using readily accessible implements (such as cutlery). And they should require a special tool or key for removal
It’s important to note that any windows fitted with initial opening restrictors are not suitable in social care premises where individuals are at risk, as they can be easily overridden.
What if care home providers don’t follow standards?
Typically the Care and Quality Commission (or Care Inspectorate), the Police and the HSE/Local Authority will lead an investigation into a non-natural death.
Should a care home provider be found to fall short of these standards it may be viewed as gross negligence and could lead, in the event of a fatality, to charges of corporate or gross negligence manslaughter or homicide.
Even without a fatality the new sentencing guidelines for health & safety offences allow judges to pass sentences based on the likely outcome of a breach.
Given that a fall from height is likely to be fatal or at least result in life-changing injury, failure to provide adequate restrictors on windows in a care home environment could result in substantial fines.
What action should you take?
All care homes should ensure that as windows are fitted or replaced they have suitable restrictors detailed in the specification.
Integral restrictors should be checked to make sure they are suitable for the care industry and not a domestic environment. Restrictors must be able to withstand a deliberate attempt to bypass the restrictor or otherwise defeat it.
Where windows are in place review the suitability of your window restrictors.
It is unlikely that a short length of chain secured by screws will be suitable; the chain will readily snap under pressure and a knife could be used to undo the screws.
Where commercial restrictors are fitted which require a key to open, make sure the keys are secured and that the locks are not easily defeated with a knife or small screwdriver.
This type of lock should be fixed to the windows with non-standard screws such as star headed screws of one directional fixings which can’t be easily removed.