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Unauthorised Restraint Technique – Care Home Patient Death

A patient at a Nottinghamshire mental health hospital died after being restrained by a member of staff – the member of staff is said to have used an unauthorised restraint technique.

What happened?

In a prosecution brought by the Health and Safety Executive (HSE), Nottingham Crown Court heard that Derek Lovegrove, 38, died of a cardiac arrest after being restrained by a member of staff at Castlebeck Care (Teesdale) Ltd care home.

The Court heard that on the night of his death, Mr Lovegrove – who was classed as a high risk patient due to his tendency towards violence – had made a grab for two members of staff in a corridor.

The care workers successfully calmed Mr Lovegrove, and returned him to his room. Once inside the room, Mr Lovegrove pulled one of the workers to the floor. The worker restrained the patient by lying on top of him.

A co-worker entered the room and tried to return Mr Lovegrove to his feet. The workers realised that the man was not responding, and dialled 999.

What was the outcome?

Paramedics pronounced Mr Lovegrove dead at the scene.

Following an investigation into the death, HSE discovered that the level of care afforded to Mr Lovegrove at the care home was not in keeping with his best interests.

Sufficient restraint techniques had been in place, but following a recommendation from the Healthcare Commission , the care home had opted to switch to a conflict-avoidance technique.

Staff had noted that, in the case of Mr Lovegrove, the updated methods were inferior.

HSE Principal Inspector Frank Lomas commented:

“There was a failure to implement specific recommendations relating to
the management of Mr Lovegrove’s behaviour made in a report by
Maybo in September 2005, and a failure to implement
requirements and recommendations made by the
Healthcare Commission following a
visit in February 2006.

“The support worker should not have been left alone with Mr Lovegrove.
If another member of staff had been observing as required by
the care plan, it would have been less likely that
events would have unfolded in the way they did.
Consequently this would have reduced the
risk to Mr Lovegrove and staff.”

Castlebeck Care (Teesdale) Ltd was found guilty of breaching the Health and Safety at Work Act 1974.

The company was fined £100,000

Source: View Article

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