Dear Ms. Crawford. Kenneth Granville Cottam deceased Reg28 Report We are writing in response to the Matters of Concern which are as follows, and t0 reassure the Coroner' s Court that we, aS a matter of course, do all that we can for our Residents in the subject of (1) The Court was not reassured that there are clear and robust policies and procedures in place in relation to falls risk assessment and management_ (2) The Court was not reassured that staff had a sufficient understanding of the falls policies and procedures in place to enable them to implement them consistently and appropriately. You have in your possession some documentation that I delivered to your office the after the Inquest; i.e. on 8rh November 2017, being documents that we had had with us at the Inquest but which were not brought to your attention at the time. That documentation included the items listed on the attached to Inquest re Mr: Cottam 07/11/2017,!. We now enclose the following: Falls Policies?_ All staff sign a *Policy Checklist' form once when they join the Company to prove that have been shown the Policies and where are kept, and then sign again annually; and are encouraged to re-read the Policies and Procedures as often as possible: Continued overleaf List of documents taken to Coroner's Office on 07/11/2017 Falls and Accident Reporting Policy Enjoy your retirement years in elegant 4 surroundings with the support of top quality; family style care G Registered No. 1746888 Ms: falling: day Taking they they they Policy

When there is an accident O incident; the staff who is * first on the scene' completes an accident report form: This gets sent to the Office Manager; who checks that the General Manager has seen it indicated by the General Manager'$ signature on the form (obviously if she hasn t, the form is sent to her). The Office Manager checks whether it is a matter that needs further investigation, Or whether the matter has been dealt with and the Resident is all right so that the form can be filed: The General Manager also does this; but also ensures that the fall,ifit was a fall, is noted on the Falls Audit form and all other procedures have been attended
i.e. the following procedures which are carried out by Carers and Senior Carers: She will check the Daily Care Report entries by the care staff: She will check that a Body has been done. Body Mapping Policy attached'. She will check that there is a Falls and Incident Analysis formS in the Resident'$ Support Plan (perhaps this is a first incident and there wasn t one previously) Staff know that for each fall, the following forms must be completed, so the General Manager will also check that these have been done: Falls Risk Assessment Toolb; Falls Risk Assessment Screening Tool"; Falls Checklist Environmental Factors Following Risk Assessment for when there is a high risk of falls' form is commenced on the occasion of a second fall: There are two versions of this risk assessment as some Residents prefer that their falls mat is plugged in only at night for example, so the alternative risk assessment is then used. We that the above answers the Regulation 28. We should be very grateful if you would please let us know if it does not.