Review into death of Amanda Richards finds risks not properly considered before removal of 24-hour care, which could have prevented house fire

A disabled woman who lived alone died in a fire at her Coventry home after funding that had provided her with 24-hour care was cut.

A review into the death of Amanda Richards, 40, has found that there was an inadequate risk assessment carried out into the dangers of leaving her unsupervised for two hours each day, especially in relation to her smoking habit.

Richards suffered from a degenerative neurological disease that affected her coordination and confined her to a wheelchair and had been on her own when a cigarette started the fire that ripped through her bungalow in December 2013.

Funding for her care came via a direct payment from the council, but the money was sourced from a range of areas including the local NHS, which reduced its financial contribution in 2011 following a review.



A serious incident review by the Coventry safeguarding adults board stated this week that insufficient attention was given as to whether the existing package of care needed to continue, irrespective of the funding provider, when the funding was withdrawn.

It said: “An assessment of need and risk should have followed and a separate multi-agency decision agreement developed to address any service gaps.”

The review added: “Risk relating to fire associated with her smoking while unsupervised was not sufficiently explored in the assessments or care plan, despite acknowledgement of her lack of awareness of hazards coupled with knowledge of her smoking habit and her difficulties in coordination and dropping items.”

The report also found that relatives’ concerns about the sustainability of the care plan had not been properly considered.

While it stated that it could not conclude that the absence of a carer was responsible for Richards’ death, it said it found that the presence of a carer would have increased the likelihood that the fire could have been dealt with or she could have been helped to escape.

An action plan, accompanying the serious case review, has since been reviewed by the council’s scrutiny board who felt recommended changes to council procedures did not go far enough. The board’s recommendations are due to be considered by the council’s cabinet member for health next week.