Coroner urges more patient checks at care home
A pensioner with mental health issues who killed himself the day after being admitted to a care home should have been checked on more, a coroner said.
Tin-Sang Li, 83, had been able to lock himself in his room at Norwood Green Care Home in Southall, west London, despite a history of depression.
Care workers forced the door open but were too shocked to act, the inquest heard.
Assistant coroner Lorna Tagliavini urged for improvements.
Speaking at West London Coroner's Court Ms Tagliavini said: "Mr Li took his own life, contributed to by failing to carry out any frequent and regular observations having regard to both his status as a new resident and his increased level of depression."
She said while Mr Li's life could not have been saved, as police arrived shortly afterwards and reported his body was cold and stiff, she was concerned at the lack of reaction from staff members.
She told the inquest she was going to write a report urging that care home staff should be sufficiently trained to deal with such situations.
She said: "I want to see members of staff who come across these shocking scenes springing into action in accordance with training they have been given."
Hong Kong-born retired chef Mr Li had been admitted to the care home, run by the Four Seasons group, on 25 February last year upon his discharge from the West Middlesex Hospital.
His stay at the home was supposed to be temporary while more permanent accommodation was found, as Mr Li could no longer look after himself at home.
A care home spokeswoman said the day after Mr Li's death the locks were changed so residents could not lock themselves in.
The Four Seasons group also has a new policy to deal with suicide prevention, the inquest heard.