Dear Sir, This is a response to some concerns raised by the coroner following an investigation into a death of one of our service users Mr Peter Harte. Firstly, I think it is imperative to remember that the service user in question had extreme behaviours that challenges, and the care plans can evidence the actions needed to try and de-escalate and overcome the service users’ distress and agitation. When the service user moved into the service, he was under one of our enablement beds. This is a bed that enables multi-disciplinary team members to assess, collate and facilitate care and identify necessary treatment for illness etc. The service user was showing challenging behaviour where he was aggressive, agitated and obviously distressed by the situation and the environment, this usually calms after a couple of days as people with dementia are unable to cope with changes in their environment, although this was not the case with peter. The staff who looked after this service user had all the relevant experience and training to facilitate and identify techniques to reduce distress. The service user would not settle in their bed and would spend almost all of the day and night on the floor. Crash mats was therefore put in place. We see this sort of behaviour often in our environment and client group that we look after. In Peters case he found the floor comforting and preferred to remain on the floor. when trying to encourage peter to go to bed this heightened his agitation. That being said, this service user was still provided with all the necessary care, support, and empathy throughout their stay in the service. The nursing staff and care team identified potential concerns with his health and flagged these up to the relevant MDT members for treatment and assessment, this included both the GP and the mental health team to offer the service user and staff support to try and overcome/resolve the service user’s challenging behaviours and agitation. When peter was admitted to Bromford lane there were numerous wounds bruise on his body. Throughout the service users stay and on admission the staff had completed mandatory body maps for multiple bruises, scars, scabs etc all at various stages of healing, these can be identified on the body maps shared to the coroner. This in itself was a challenging task as the service user was often non-compliant with many aspects of his care and treatment and would show behaviour that challenges by being aggressive towards staff. He was also mostly on the floor meaning that staff would try and discreetly and check skin integrity to try and reduce this service users’ distress and maintain their privacy and dignity. (We often discreetly check skin for many service users who are non-compliant, this is often done in the service user best interests and on occasions can be extremely difficult to complete accurately due to lashing out or the service user not able to keep still). When we say discreetly, we would have to try and gain inspection of peters body when doing personal care dealing with his incontinent needs and although some areas of his body were mapped on discussion with staff that delivered care to peter they found it extremely difficult due to peter lashing out at them. The staff who was looking after the peter on the days in question have explained that the peter was distressed, and they had done everything they could to reduce his distress and both nursing and care staff had tried to complete body maps however had been unsuccessful for some of the pre-existing wounds. However, the body maps for the 16/3/2021 18/3/21 had been completed where possible by the staff on the 15/3/21 and 17/3/2021 peter was non-compliant all day when staff approached peter, he bit punched and slapped them. so interventions were limited due to peters agitation but observations still took place. In the evidence pack provided to the coroner ABC charts was in place on both these days as peter was uncompliant with personnel care on both days. All staff have been spoken to and have received feedback and support to follow paperwork protocol if unable to follow

Bromford lane care centre RE Peter Heart 18/10/2021 process. Documentation needs to be put in place. After coroner’s court I sat back and reflected on what was said and discussed with staff who had nursed peter, they felt they had provided good care to peter but found it very difficult to provide personnel care due to his behaviours. So throughout the days they ensured he received care in his best interest his personnel care, eating drinking and incontinent needs, which took many attempts on every occasion but our staff continued to ensure his well being and keep his dignity. Staff fully understand the importance of body maps and why we do them, but due to the difficult circumstance with peters challenging behaviour staff felt they couldn’t do anymore for peter than they already had. Following this review, we have had an external auditor come and audit our body maps to ensure that they are being completed accurately for all service users . This identified that we are completing body maps in a timely manner and that staff are aware of the importance of skin integrity, how to check for concerns and how to report any concerns to the relevant staff member. I think it is essential to understand that at Bromford lane we pride ourselves on ensuring that the most complex service user group are supported with all aspects of their care. This can in itself provide us with some challenges we as a team feel we are very responsive to the service user’s well- being and any concerns or changes are reported to the relevant MDT member to ensure we have all the support needed to offer the best quality of life for the most complex client group. We have a very good rapport with the local services and they often express that they feel we absolutely do thing as needed to provide best care and sometimes this is in the most extreme circumstances. We will of course continue to monitor the service quality and identify areas of improvement required and ensure that the staff are offered suitable training and ongoing supervision and support as required. Many thanks

Home manager

Bromford lane care centre RE Peter Heart 18/10/2021

The staff who was looking after the service user on the days in question have explained that the service user was distressed, and they had done everything they could to reduce his distress and both nursing and care staff had tried to complete body maps however had been unsuccessful for some of the pre-existing wounds. However, the body mas had been completed where possible by the staff. All staff have been spoken to and have received feedback and support to improve the service provided Following this review, we have had an external auditor come and audit our body maps to ensure that they are being completed accurately. This identified that we are completing body maps in a timely manner and that staff are aware of the importance of skin integrity, how to check for concerns and how to report any concerns to the relevant staff member. I think it is essential to understand that at Bromford lane we pride ourselves on ensuring that the most complex service user group are supported with all aspects of their care. This can in itself provide us with some challenges we as a team feel we are very responsive to the service user’s well- being and any concerns or changes are reported to the relevant MDT member to ensure we have all the support needed to offer the best quality of life for the most complex client group. We have a very good rapport with the local services and they often express that they feel we absolutely do thing as needed to provide best care and sometimes this is in the most extreme circumstances. We will of course continue to monitor the service quality and identify areas of improvement required and ensure that the staff are offered suitable training and ongoing supervision and support as required. Many thanks

The team at Bromford lane care centre