5 Feb 2016 Samantha MacDonald · Prevention of Future Deaths report Manchester West
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Concerns raised 2 Failure to keep bedroom window restrictors in good working order View source Failure of bedroom window restrictors to resist determined efforts to open windows View source
Actions described in response An action is something this recipient says it has done, is doing, or plans to do in response to the concern raised. 4
Action
Inspect window restrictors each student term and before new intake, repairing damage and notifying students of sanctions where necessary.
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Action
Display warnings and develop separate safety procedures when work requires removal of window restrictors.
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Action
Enforce a signed student rule prohibiting interference with or removal of window restrictors.
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Action
Conduct daily external checks for overcome window restrictors, taking action against students and reinstating restrictors when issues are identified.
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AI-generated summary
Samantha MacDonald · Prevention of Future Deaths report
This summary was generated using AI from the published report. Please read the original report for the complete account.
Report summary
On 25 October 2015, 20-year-old Samantha Jane MacDonald jumped from the window of her bedroom on the 14th floor of student accommodation in Salford and died. The window restrictor, which would have prevented the window opening sufficiently, was broken; similar devices in the building had also been found broken, raising concerns about the robustness and assessment of window restrictors in student accommodation.
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× Source evidence
How this individual concern was interpreted PFD Monitor created a concise, searchable interpretation from the report wording shown below. The report was sent to Campus Living Villages UK Limited; that does not assign responsibility.
PFD Monitor interpretation Failure to keep bedroom window restrictors in good working order
Wider context from the report “Samantha Macdonald jumped from the window of her bedroom on the 14th floor of her student accommodation in Salford. The window was not required to be used as a fire exit because it was too high. The window was fitted with a device that restricted the distance for which it would open. Evidence was heard that the device complied with the relevant British Standard and Planning regulations. If it had been in good working order it would have prevented the window from opening sufficiently to allow Samantha’s exit. It was, however, broken. Evidence revealed that the device could be broken by the application of force without the use of any tool. It was not possible to discover exactly when the device had been broken although it had been working during Samantha’s tenancy. Similar devices fitted to other bedrooms in the building had been found to be broken from time to time. The building is a non-smoking building that is entirely devoted to student accommodation, and witnesses believed that the devices had probably been broken so that students smoking in their rooms could avoid detection. Evidence was heard that in accommodation occupied by adults who might be determined to forcibly defeat window restrictors, for example in a healthcare setting, risk assessments were recommended to be reviewed and consideration given to replacing restrictors with more substantial or robust devices, and /or adding a second restrictor to better resist determined efforts to open the window, thus lessening the risk of persons falling either accidentally or otherwise. It is considered that such assessments would also be appropriate in student accommodation such as that occupied by Samantha Macdonald.
” Open source report × Source evidence
How this individual concern was interpreted PFD Monitor created a concise, searchable interpretation from the report wording shown below. The report was sent to Campus Living Villages UK Limited; that does not assign responsibility.
PFD Monitor interpretation Failure of bedroom window restrictors to resist determined efforts to open windows
Wider context from the report “Samantha Macdonald jumped from the window of her bedroom on the 14th floor of her student accommodation in Salford. The window was not required to be used as a fire exit because it was too high. The window was fitted with a device that restricted the distance for which it would open. Evidence was heard that the device complied with the relevant British Standard and Planning regulations. If it had been in good working order it would have prevented the window from opening sufficiently to allow Samantha’s exit. It was, however, broken. Evidence revealed that the device could be broken by the application of force without the use of any tool. It was not possible to discover exactly when the device had been broken although it had been working during Samantha’s tenancy. Similar devices fitted to other bedrooms in the building had been found to be broken from time to time. The building is a non-smoking building that is entirely devoted to student accommodation, and witnesses believed that the devices had probably been broken so that students smoking in their rooms could avoid detection. Evidence was heard that in accommodation occupied by adults who might be determined to forcibly defeat window restrictors, for example in a healthcare setting, risk assessments were recommended to be reviewed and consideration given to replacing restrictors with more substantial or robust devices, and /or adding a second restrictor to better resist determined efforts to open the window , thus lessening the risk of persons falling either accidentally or otherwise. It is considered that such assessments would also be appropriate in student accommodation such as that occupied by Samantha Macdonald.
” Open source report
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Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Inspect window restrictors each student term and before new intake, repairing damage and notifying students of sanctions where necessary.
Verbatim wording from the response “• Carried out checks of the latest each student term and prior to new student intake in September, including specific checks on window restrictors. Where window restrictors had been damaged or tampered with, CLV fixed the restrictors and issued a letter to the student concerned informing them of the potential for fines and/or disciplinary action should they break the window restrictor again.”
Source location 2016-0036-Response-by-Campus-Living-Villages Page 2 · response Published 2 February 2016
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Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Display warnings and develop separate safety procedures when work requires removal of window restrictors.
Verbatim wording from the response “• When work is taking place at CLV properties which requires the removal of window restrictors, warning signs are put in place and separately safety procedures are developed.”
Source location 2016-0036-Response-by-Campus-Living-Villages Page 2 · response Published 2 February 2016
Open published response
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Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Enforce a signed student rule prohibiting interference with or removal of window restrictors.
Verbatim wording from the response “• Included a specific prohibition in ‘The Village Rules’, which students have to sign up to when renting a property. This states: “Window opening restrictor system is for your safety and must not be interfered with or removed. …Violation of this policy may, at the discretion of Village management, result in disciplinary action and a fine.””
Source location 2016-0036-Response-by-Campus-Living-Villages Page 2 · response Published 2 February 2016
Open published response
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Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Conduct daily external checks for overcome window restrictors, taking action against students and reinstating restrictors when issues are identified.
Verbatim wording from the response “In relation to risks associated with accidental falls, associated with broken or damaged restrictors, or those which are ineffective for any other reason (e.g. opened for window purposes), additional steps have now been put in place on top of those in place at the time of incident. These include:”
Source location 2016-0036-Response-by-Campus-Living-Villages Page 2 · response Published 2 February 2016
Open published response
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Source evidence
How this respondent position was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Additional or more robust window restrictors are not considered the most effective or appropriate control for deliberate falls in a normal university setting.
Verbatim wording from the response “We have considered the comments made in your Regulation 28 report about the potential use of secondary restrictors and/or more robust devices. As set out at the start of this report, we do not consider CLV to have the same risk profile or duties (and powers) of a healthcare organisation.”
Source location 2016-0036-Response-by-Campus-Living-Villages Page 2 · response Published 2 February 2016
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Source evidence
How this respondent position was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation The risk that force could break compliant window restrictors and cause accidental falls is considered eliminated and controlled by existing restrictors.
Verbatim wording from the response “We have specifically considered the suggestion made at inquest that the application of force (rather than use of a tool) could result in window restrictors breaking. In the context of accidental falls, this has been considered and eliminated as a real risk and one that it is controlled through the use of restrictors complying with BS EN 14351.”
Source location 2016-0036-Response-by-Campus-Living-Villages Page 2 · response Published 2 February 2016
Open published response