A vulnerable 86-year-old man died at a Barnes care home after being fatally assaulted by a fellow resident with dementia, an inquest has heard.
Neil Sweetmore, a former actor and BBC costume department employee, was attacked by John Edgar at Viera Gray House on August 25, 2020 – the same day he returned from hospital following an earlier alleged assault by the same man.
The three-day inquest at West London Coroner’s Court heard that Edgar had previously attacked Sweetmore twice before the final incident, with staff recording escalating violence and aggression as Edgar’s dementia advanced.
“I’m going to die today”
On returning to the Greensleeves Care-run facility, Sweetmore reportedly told staff: “I don’t want to stay here. I’m going to die today.”
That evening, Edgar was discovered kicking Sweetmore on the floor of a corridor. A paramedic’s statement described how Sweetmore had received “several stamps to the face, chest and abdomen” during an attack lasting approximately five minutes.
Sweetmore died of pneumonia on 11 September 2020, which developed after surgery for head injuries sustained in the assault. CT scans showed evidence of both old and recent bleeding near his brain, consistent with the alleged attacks of August 7 and 25.
The inquest heard that Edgar, who has since died, had been involved in six violent incidents between April and May 2020, just a month after joining the care home. These included throwing a heater at a female resident and attempting to strangle a carer.
Staff had expressed concerns about Edgar’s territorial behavior toward his wife, who was also a resident in the later stages of dementia. Former staff claimed Edgar had made homophobic remarks about Sweetmore and had “taken a dislike” to him.
Failures in communication
The court heard of significant failures in safeguarding procedures. The first alleged assault on 16 July 2020, was not reported to the Care Quality Commission or Richmond Council’s Adult Social Services as required.
Eleanor Watson-West, the home’s registered manager until 2022, told the inquest she had sought support for Edgar from mental health services but “felt like I wasn’t really getting the support that I needed.”
Claire McMahon from Richmond Council said the authority was not properly informed of Edgar’s escalating behaviour or of key incidents, meaning they “just didn’t see the bigger picture of risk.”
A former carer described Edgar’s final assault as “entirely preventable” if all staff had been properly briefed when Sweetmore returned from hospital.
Despite family concerns raised in an email on August 10 about Edgar’s need for antipsychotic medication and the possibility of psychiatric hospitalization, Edgar remained at the facility until after the fatal attack. He received new medication on August 23, just two days before the final incident.
About the victims
Sweetmore was described as a “wonderful man, very gentle and sociable” with a passion for theatre, film and ballet. He had starred in stage shows across the country before working in the BBC’s costume department until 2013. His partner of 40 years had died in 2015.
Edgar was characterized as a “lovely man” and devoted husband whose behavior changed dramatically as his dementia progressed.
After the attack, Edgar was sectioned and taken to a psychiatric hospital, where it was reported he had settled.
Coroner Lydia Brown is expected to deliver her findings on Thursday, September 4. The case highlights ongoing concerns about safeguarding vulnerable residents in care homes and the challenges of managing patients with advancing dementia.
This case was first reported by Local Democracy Reporter Charlotte Lilywhite.
