Give care home staff the proper training on modified diets – say Shoosmiths Serious Injury experts

09 February 2022

Shoosmiths serious injury experts have called for care home staff to be given ‘clear guidance and training on modified diets’ following the second tragic death of an HC-One care home resident in six years.

Their calls come after news that HC-One Limited, a company who own and run care homes throughout the UK, were fined £640,000 after a resident in one of their care homes choked on a doughnut and died in August 2019.

This followed the case of Olive Parker, who died at Fir Trees Care Home in Tameside in 2016 - another home operated by HC-One.

Sarah Cunliffe, Senior Associate for Shoosmiths serious injury, was instructed on Olive’s case in 2017, and was deeply concerned to hear about the recent case.

Sarah said: “I was deeply concerned to hear about the recent HSE case involving the resident at Orchard House which bore many similarities to Olive Parker’s case.

“A doughnut is unsuitable for someone who ought to be on a minced and moist/mashable diet. It is concerning to hear that HC-One have not learnt from their mistakes.”

“Staff ought to have been aware of the resident’s dietary needs and her care plans ought to have been amended to reflect the same.”

A court heard last month that the 65-year-old female resident at Orchard Care Home in Clackmanannshire, a home run by HC-One, had previously suffered from a stroke and had been diagnosed with dementia. She had been assessed as being at high risk of choking and consequently was on a ‘minced and moist/fork mashable’ diet.

However, in August 2019, she was given a jam doughnut from the snack trolley. Main meals at the home were labelled with each resident's name, but the snack trolley did not have information on those who were required to avoid certain foods, the court heard.

The hearing also found prior to her death, she had frequently been given sandwiches from the snack trolley, which repeatedly put her at risk of choking.

HC-One pleaded guilty to breaching the Health and Safety at Work Act, as the HSE’s investigation revealed that staff in charge of the trolley had also not been given sufficient training on modified diets.

In 2017 Sarah Cunliffe was approached by the family of Mrs Olive Parker following Olive’s death at Fir Trees Care Home, Tameside. Olive had dementia and had a number of food related choking episodes prior to moving to the home. She had been referred to the speech and language therapy team (SALT) for an assessment and she was placed on a modified diet.

Sadly, on 24 August 2016, Olive was given the choice of her evening meal. As a result of her dementia, she was not able to appreciate the risks which certain foods posed, and she should not therefore have been given the options she was presented with. Unfortunately, Olive chose to have chicken nuggets.

Contrary to her care plan, Olive was also left unsupervised to eat her meal. Around 40 minutes later when the carer returned to collect Olive’s plate, she was found unresponsive. Despite the best efforts of the paramedics, Olive was pronounced dead.

Sarah was approached to assist the family at an inquest. At the inquest, which concluded in June 2018, the coroner returned a narrative verdict of neglect. Following the inquest, Sarah successfully pursued a civil claim for damages on behalf of Olive’s estate.

Sarah now stressed that it is vital that lessons are learnt in relation to both cases.

She said: “It is vital that all steps are taken to ensure residents are given meals which are suitable for them.

“Had staff been provided with clear guidance and training as to what these ladies could and could not eat, their deaths may have been prevented.”



This information is for educational purposes only and does not constitute legal advice. It is recommended that specific professional advice is sought before acting on any of the information given. © Shoosmiths LLP 2024

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