Sandra Barnett
PFD Report
All Responded
Ref: 2024-0019
All 1 response received
· Deadline: 15 Mar 2024
Coroner's Concerns (AI summary)
The staircase at a holiday rental may not have met safety regulation standards for width, depth, and handrails at the time of a fatal fall, indicating a potential ongoing risk.
View full coroner's concerns
During the course, of the inquest the evidence revealed matters giving rise to concern. In my opinion there is a risk that future deaths will occur unless action is taken. : «AuthorisingUserFullName» «AuthorisingUserAppointment»
Responses
Action Taken
Following the incident, the property owners added a second handrail to the staircase, fitted permanent stairgates, and added further information to the AirBnb web pages and Visitors Information pack giving advance notice that this is an old property with steps and stairs. (AI summary)
Following the incident, the property owners added a second handrail to the staircase, fitted permanent stairgates, and added further information to the AirBnb web pages and Visitors Information pack giving advance notice that this is an old property with steps and stairs. (AI summary)
View full response
Dear Mr Cooper Regulation 28 Report Mrs Sandra Barnett - Response I am in receipt of your report which relates to a property at Holme Farm,
. Please would you note that our names and address for correspondence is as above. The letter was delivered but as the property is not permanently occupied, the mailbox is not checked regularly hence the delay in responding to you. Context: Holme Farm is a detached farmhouse dating back largely to the Victorian period although there is evidence of an earlier farmhouse due to different levels on the ground floor. The property was extensively renovated in 2019/2020. We did in fact do some alterations to the staircase at the top where there was a very narrow tread at the point where it splits into the two accesses to different parts of the house. We enlarged the tread to make it wider and replaced the stair carpet. We discussed replacing the whole staircase with the joiner to make it meet modern standards. However, we were unable to find a solution that retained the historic integrity of the farmhouse without substantial alteration to rooms at both levels. We began letting Holme Farm in October 2020 and the Barnett family were one of the first visitors that we welcomed. We have continued to let Holme Farm without any similar incidents or reports from any visitors of safety issues. Action taken: Following the second visit of the Barnett family in April 2021 and the tragic accident, we immediately took the following steps to prevent future accidents in and around the staircase:
1. A second handrail was added to the wall so that both hands could be used to use the stairs if required.
2. The temporary use of stairgates was ceased and permanent stairgates were fitted at the bottom and at both access points at the top of the stairs.
3. Further information was added to the AirBnb web pages and the Visitors Information pack giving advance notice that this is an old property with steps and stairs and that visitors should be aware and take care if they have mobility issues. I -attach some photographs to illustrate the above.
As you can imagine we were deeply shocked at the tragic death of Mrs Barnett especially as we had met her and talked about. the th.ings she had enjoyed during her holiday stay at Holme Farm. Our heartfelt condolences go to her husband and wider family.
. Please would you note that our names and address for correspondence is as above. The letter was delivered but as the property is not permanently occupied, the mailbox is not checked regularly hence the delay in responding to you. Context: Holme Farm is a detached farmhouse dating back largely to the Victorian period although there is evidence of an earlier farmhouse due to different levels on the ground floor. The property was extensively renovated in 2019/2020. We did in fact do some alterations to the staircase at the top where there was a very narrow tread at the point where it splits into the two accesses to different parts of the house. We enlarged the tread to make it wider and replaced the stair carpet. We discussed replacing the whole staircase with the joiner to make it meet modern standards. However, we were unable to find a solution that retained the historic integrity of the farmhouse without substantial alteration to rooms at both levels. We began letting Holme Farm in October 2020 and the Barnett family were one of the first visitors that we welcomed. We have continued to let Holme Farm without any similar incidents or reports from any visitors of safety issues. Action taken: Following the second visit of the Barnett family in April 2021 and the tragic accident, we immediately took the following steps to prevent future accidents in and around the staircase:
1. A second handrail was added to the wall so that both hands could be used to use the stairs if required.
2. The temporary use of stairgates was ceased and permanent stairgates were fitted at the bottom and at both access points at the top of the stairs.
3. Further information was added to the AirBnb web pages and the Visitors Information pack giving advance notice that this is an old property with steps and stairs and that visitors should be aware and take care if they have mobility issues. I -attach some photographs to illustrate the above.
As you can imagine we were deeply shocked at the tragic death of Mrs Barnett especially as we had met her and talked about. the th.ings she had enjoyed during her holiday stay at Holme Farm. Our heartfelt condolences go to her husband and wider family.
Sent To
- Holme Farm
Response Status
Linked responses
1 of 1
56-Day Deadline
15 Mar 2024
All responses received
About PFD responses
Organisations named in PFD reports must respond within 56 days explaining what actions they are taking.
Source: Courts and Tribunals Judiciary
Report Sections
Investigation and Inquest
1a. Traumatic Subdural Haematoma (Operated) 1b. 1c.
Circumstances of the Death
Name of deceased: Mrs Sandra BARNETT Following an unwitnessed fall downstairs whilst on holiday in Grimsby, which occurred at 22:30 hrs on 16/04/2021 at a holiday let hosted by Airbnb (Holme Farm,
). The deceased was admitted to Grimsby A&E before being transferred to Hull for a decompressive craniotomy and subsequently transferred to RBH on 05/05. Underwent further surgery at RPH. Post op transferred to Critical Care. Sedation was removed however patient did not.wake. An EEG initially showed seizure activity. Treated with antiepileptics but her conscious level did not improve. Further imaging CT and MRI scan showed further evidence of haemorrhage in brainstem. A family conference resulted in the decision for EOL care and tre~tment was withdrawn. Patient continued to deteriorate and died. Death verified 21/05/2021 at 1857 hrs. CORONE~SCONCERNS During the course, of the inquest the evidence revealed matters giving rise to concern. In my opinion there is a risk that future deaths will occur unless action is taken. In the circumstances it is my statutory duty to report to you: The MATTERS OF CONCERN are as follows. «AuthorisingUserFullName» «AuthorisingUserAppointment» County of Lincolnshire At the time of the fall did the staircase at the holiday home meet regulation standards as to width, depth, handrails and if not, has any remedial work been undertaken since.
). The deceased was admitted to Grimsby A&E before being transferred to Hull for a decompressive craniotomy and subsequently transferred to RBH on 05/05. Underwent further surgery at RPH. Post op transferred to Critical Care. Sedation was removed however patient did not.wake. An EEG initially showed seizure activity. Treated with antiepileptics but her conscious level did not improve. Further imaging CT and MRI scan showed further evidence of haemorrhage in brainstem. A family conference resulted in the decision for EOL care and tre~tment was withdrawn. Patient continued to deteriorate and died. Death verified 21/05/2021 at 1857 hrs. CORONE~SCONCERNS During the course, of the inquest the evidence revealed matters giving rise to concern. In my opinion there is a risk that future deaths will occur unless action is taken. In the circumstances it is my statutory duty to report to you: The MATTERS OF CONCERN are as follows. «AuthorisingUserFullName» «AuthorisingUserAppointment» County of Lincolnshire At the time of the fall did the staircase at the holiday home meet regulation standards as to width, depth, handrails and if not, has any remedial work been undertaken since.
Action Should Be Taken
In my opinion possible action should be taken to prevent future deaths and I believe you have the power to take such action.
Similar PFD Reports
Reports sharing organisations, categories, or themes
Related Inquiry Recommendations
Public inquiry recommendations addressing similar themes
Review CCTV monitoring SIA licence requirements
Manchester Arena Inquiry
Unregulated recreation safety
Establish standard for event healthcare services
Manchester Arena Inquiry
Unregulated recreation safety
Mandatory Ambulance Liaison Officer at events
Manchester Arena Inquiry
Unregulated recreation safety
Data sourced from Courts and Tribunals Judiciary under the Open Government Licence.