Grandad Richard Swann died days after head injury fall at Asterbury Place care home, Ipswich

An Ipswich great-grandfather died in hospital four days after a head injury which he suffered in a fall at a care home was not reported to the on-call doctor, an inquest has heard.

Richard Swann, 93, was treated with a cold flannel after he fell and hit his head on his bedside table at Asterbury Place care home in Aster Road, Ipswich.

The senior care assistant who witnessed the incident but did not notify the on-call emergency doctor has been dismissed by Care UK, which runs the care home.

Mr Swann, a Second World War veteran, moved into the care home in December 2015. He was blind, deaf and had a history of falls.

At 2am on January 17 last year, he hit his head on his bedside table when he lost balance and fell on his way to his bathroom. He was checked over and a cold flannel was applied to his head. Mr Swann said “he was fine” and fell asleep at 4am.

The head injury was not reported in the handover to the unit’s team leader on Monday morning, the inquest was told.

He was admitted to Ipswich Hospital’s emergency department after being found “slumped” in his bedroom chair on January 19. He died at the hospital on January 21.

A police investigation into his death found no criminal activity.

A scull fracture was not identified at the hospital.

Assistant coroner Nigel Parsley recorded a verdict of accidental death at an inquest into Mr Swann’s death on Monday. The medical cause of death was 1A head injury, due to a fall, and 1B bronchopneumonia. Neglect was not a contributory factor, he said.

He said: “It is clear that procedures were not followed. It is clear that there were missed opportunities where treatment could have been given. That said, Richard was 93 and we can never second guess how that would have changed the sequence of events.”

Speaking after, granddaughter Sharon Elmy, 48, of Ipswich, said: “He was just fantastic. He would always cheer you up. But we are not silly; it (his death) could have been his next fall. But he did not deserve to die this way, in pain.”

Phillip Steyn, regional director at Care UK, said: “We have very strict processes in place for team members to follow if someone has a fall. This requires the team member to speak to a medical professional immediately after a fall. The colleague concerned who did not follow that process was suspended and, following a disciplinary, was dismissed.”