RETIRED university administrator Vivian Dunsby died when he slipped while climbing from a first-floor window at a residential home where he had lived for just a month, an inquest heard.

Mr Dunsby, 81, had been moved by his family into St John's House in Parker Lane, Kirk Hammerton, near York, after becoming prone to periods of forgetfulness while living alone.

A month into an eight-week trial period Mr Dunsby removed a chain across a balcony window in his room and snapped another chain on the toilet window.

He climbed out on to a four-inch wide ledge, slipped and fell while trying to reach a drainpipe, crashing to the ground and sustaining multiple injuries.

Coroner Geoff Fell, who recorded an accidental death verdict, told a Harrogate inquest Mr Dunsby had been wearing slippers at the time and it would have taken some agility to reach the pipe.

A night worker at the home, Jane Murtagh, said she had twice found Mr Dunsby in rooms other than his own but he had then settled down. Checks had shown nothing untoward later in the night and at 5.20 am when Mr Dunsby was not in bed she had assumed he was in the bathroom, where the light was on.

Mr Fell said neither he nor the National Care Standards Commission - which had conducted its own investigation - had any criticism of the home. It was adequately staffed and residents were checked regularly.

Its owner and manager, Linden Veitch, had arranged for an appointment Mr Dunsby had at Harrogate District Hospital's Briary Unit for people with mental problems to be brought forward because of his forgetfulness and disorientation.

But a fortnight before the hospital visit Mr Dunsby, who had earlier laid out clothing and pictures on his bed, had thrown some clothes out of the balcony window, and then climbed out of the toilet window.

Mr Fell said: ''I can't speculate on what was in his mind. I suspect he was confused as it would not have been difficult to leave by the front door. But he did not intend the outcome to be as it was.''

Updated: 10:42 Thursday, June 26, 2003