Dear Ms Mutch; Re: John Anthony Davies (Deceased) Thank you for your letler, of 26" April 2017 , concerning the inquest of the above named patient As always, am graleful t0 you for highlighung your concems On the Regulation 28 'Report lo prevent future deaths' and for provlding me with an opportunity to respond Your concems are as fallows: There was no process In place for risk assessment plans to be completed when a resident's needs changed from care to nursing needs and a bed was awalted: mull-agency risk assessment has been developed this will support residential home managers l provlde safe and effective care for patients have been assessed as needing twenty four hour nursing care and are walting to be transferred to a nursing home; This risk assessment is l0 be launched at the Stockport Care Home Managers' meeting in June 2017 and due to be Implemented in 2017 . The District Nureing Team were unaware of the change In status and there was no system in place to Involve them In discusslons: The Stockport District Nursing (DN) service; Iike many other District Nursing servkces, recognises the challenges associated with delivering care to patients In a resldential home When the patients care needs change from residential care status (o Contnuing Health Care (CHC) or Funded Nursing Care status. The DN team who visited this patient within the residential home were unaware that the patient's slatus had changed; the CHC Funded Nursing Care team had not informed the DN staff; nor had the staff within the residential home: The DN Pathway Lead met wilh a representative of lhe Stockport Clinical Commissioning CHC leam t0 discuss how communication could be improved between the CHC team and DN teams As a result of the discussion It been agreed lhat the CHC staff will; as a matler of course, use the Contact Access and Triage service (CATs) t0 invite DN staff lo patient CHCIFunded Nursing Care meetings. Patlent recorde complete by the District Nureing Team lacked detall and were not completed in the required timescale: The Trusts accepts that the patients District Nursing notes did Iack detail especially around the deterioration of the patients physical and mental health and were not completed in the requlred iimescale, This has been addressed with the team and a rellective session has been facilitated regarding the patient's nursing care: An audit of the team's patients' noles has been carried out by the DN Clinical Lead and improvements have been noted The Patient Records audit is being repeated (0 ensure that Ihe Improvements have been sustained. Your Health: Our Priorty: July Group has

There was no continuity of care provided by the District Nursing Team The Named Nurse for the each care home will undertake all visils to the residents within their allcaled home; however; when not on duty, the Named Nurse will hand over any relevant Information to whichever nurse is assigned t0 visit The Informatlon in the handover will include detalls regarding risks, non-compliance, patient issues and care planning: The visiting nurse will then hand over to Named Nurse when helshe is back on This process will be overseen by the Caselad holder: There was Iittle evldence of communication and information gharing between the care home and the District Nursing Team A new Named Nurse has been appointed to the residential home involved In this case. This nurse wlll ensure communicatlon and documentation is improved and this will be overseen by the DN Caseload Holder (Band 6 Nurse): The Named Nurse now attends monthly meetings at the residenlial home wllh the manager and the staff t ensure all aspects of patients' care are discussed and communlcated t the DN team The home manager will also Invite Adult Social Care slafi, District Nursing stafif; GP and home care stalf (0 the meeting for ongolng discussion of the patients' care The inforation from these meetngs wll be recorded an shared at the ON 'Time Team' meeting: Implementing the above will improve continuity of care to the resldents of the home and also improve working relationships with the staff within the home. The Care Home notes were lacking In detail The Care Home notes are not the responsibillty of the Trust; ad we respectfully request that this concem Is forwarded to the Care Home. A suitable nureing home placement could not be Identified once it had been agreed that the Care Home was no longer the best place to meet needs of Mr Davles Locating and assessing Nursing Home placements Is not the responsibllity of the District Nursing Team, and we respectfully request that this concem Is forwarded to Ihe Stockport Clinical Commissioning Group's Funded Nursing Care team t0 be addressed: Advlce was not sought by the District Nurses when they had difficulties examining Mr Davies District Nurslng staff are experienclng Increasing challenges when nursing patients wlth mental health problems or conditions assoclaled with mental health or behavioural issues. The DN team accept that advice should have been sought from other professionals when the patient's behaviour affected the lo provide DN care: Good practice would have been t0 speak Io mental health practitioners for advice or lo have undertaken a Joint visit In order t0 ensure best care was given t0 the patient: Stockport Together; major transformation programme across the health ad soclal care partners in Stockport has been Instrumenlal in enhancing multi-professlonal and multi-agency working; bringing together health professlonals from a variety of backgrounds, soclal care the third sector to benefit patient care. Community Psychiatric Nurse now attends Neighbourhood meetings on a monthly basis alongside the Psychiatric Consultant and these meetings provide an open forum for discussion about Individual patients with challenging siluations, such as in Mr Davies' case. (Consultant Psychiatric Doctor for Older People) Is also planning educatlonal events with the District Nursing staff from 2017 in order lo help and support the DN staff In the management of patients with Dementia: District Nursing staff have also been advised through discussion at Caselad Holders meetings, Locality meetings and Local Leadership and meetings that if they are Involved in the care of any residential 2 the duty: key the ability and Triage July Triage

care home patients who display signs of declining physical or mental health must oblain the conlact numbers for the patienls next of kin 50 that can make contact and discuss posslble strategies to improve compliance with care: The correct procedure was not followed on previous occasions when a trigger point was reached in relation to pressure relieving strategies The Trust has a Prevention and Management of Pressure Ulceralion Guideline (2015). All members of staff iIn the District Nursing team have been reminded of the requirement to adhere t0 this guidance ad new staff have been booked on to the mandatory pressure uker training which Includes how i0 idenlify trigger points and provide pressure relieving strategies Yours slcerely Apk Bames Chief Executive they they