A CORONER has demanded urgent changes at a Hamp-shire hospice after staff checking a sleeping child repeatedly failed to notice she had died.
Night staff at Merrydale Respite Centre checked on disabled Lydia Wyatt "six or seven times" - but she was dead for at least three hours before anyone realised.
A two-day inquest into the 11-year-old's death heard staff were not required to monitor if a child was still alive.
The checks at the centre in King's Worthy, near Winch-ester, only involved looking in to see if the child had woken or was in distress.
Southampton Coroner Keith Wiseman found that Lydia, who had cerebral palsy, died of natural causes. But he was horrified no one had thought to check if she was breathing - especially as she was fed through a tube.
Mr Wiseman said he believed Lydia's death should have been noticed sooner.
Mr Wiseman said no blame should be levelled at supervisor Janina Scarratt, who had followed Merrydale's policy to the letter.
"Any failings are of the system entirely," said Mr Wiseman.
"This cannot be allowed to be repeated. While the risk is low, what this tragedy shows is that it can occur. I would find it hard to believe if there was not a shift in the way that check is carried out."
Lydia was at Merrydale to give parents Nicholas and Georgina Wyatt, from Botley, a break for the weekend.
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