Dear Alam, Re Inquest touching the death of Alison Dawn Evers (deceased) Fhank You for your letter dated 2"d March Z15 enclosing Future Deaths addressed to Regulation 28 Report to Prevent Council. This was issued to Director of Adult Social Care of Leeds Alison Evers_ council as a result of the Inquest touching the tragic death of The Report details three matters of concern as follows: The lack of a written "no treats" policy; The lack of a policy ensuring a first aid trained member of staff is each on for (iii) The levei of first aid training %f health support workers, particularly if with service users who suffer from cognitive andlor physical working dependent on carers to meet their personal and impairment and are dietary needs_ will address each recommendation in turn but believe that before set out the scope of the services that Learning doing so it is necessary to providesnehec nighof-diergeniceustoanergroarrid Disebiesy Godihenas Support Service which it operates at vast number of bases any given time. The Learning Disability Community Support Service This Seivice exists for the purpose of serving the social care needs of disabilities and their carers_ The defining purpose OChis ndviduealised poplersoh eenieg service is to promote the best interests 0f each of its Customers and person centred It does this by: enhancing quality of their lives and experiences;

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2 by maximising their independence and reducing the need for institutional care;
3. by helping them to have a positive experience of care and support; and by safeguarding and protecting them from avoidable harm. This Service provides support to over 800 customers who present a very wide of different needs and requirements_ This Service does notDrovidenheavtercare-pernge,t8 focus is to provide social care to customers with learning disabilities The individual needs of each prospective customer are assessed prior to being accepted by this Service, and on an on; geiregebasis iftappropriate If the medical needs of a customer are or become complex severe then that person's needs are met by other more appropriate Services Or diseinceeda ofittee erearning Disability Community Support Service customers are met by three distinct and different sub-services as follows: The Supported Living_Service This Service provides support for over 300 people who are able to live their lives in their own homes or in small group with varying degrees of independence: The focus of the Service is to support and promote the customers' autonomy and independent This service is provided at over 90 separate properties within the community and level of sopport may range from just a couple f hours each week right up to full time support 24 hours a for 7 a week The autonomy of the individuals using this service and their right of self-determination and freedom pi choice is promoted, protected and respected. Customers are ffequentay with daily activities, such as using public transport; seoppingreenteet andpported supermarkets, visiting accessing community groups and public places, participating in exercise; drama and workshop groups compatible with their individual interesstband !killss Tost of the customers that this Service supports do not have any significant health needs. tpically include individuals affected by conditions such as Autism or Downs Syndrome and whilst do need social support are no more likely to need first aid than other member of the public The care staff that this Service retains are haieFirst Aadctraineany and beleve that the arrangements that are currently in place (details of which are provided below) are appropriate. In relation to a treats" policy the customers using this service usually have clear wishes about the items that purchase (with varying levels of assistance of staff members) whilst out in the community;such as a cake or confectionary "trear" at a cafe or fromerhops Il would be inappropriate, undesirable and detrimental for staff to be unable to suppof this appropriate expression of their wishes Respite Care and Crisis Service This service offers an opportunity for more than 200 customers each year to have short away from their families It also gives family carers a brecr tfeomeheir Vering reaponbibilitieays The Crisis Service provides services to customers Whose circumstances have changed or who have been affected by an emergency and provides them with care whilse moze permanent arrangements are made. settings living: the day days living visiting cafes, They they they they "no they

Vaarangeof customers and their needs from us as Service providers varies tremendously: ifnot most; of these customers do not have complex health needs. By definition, our respite customers are cared for in ordinary domestic settings where first aid experience Or refusal of treats does not form any part The purpose of the respite servicecisetoeffente @mitiestomers an enjovable change from their normal routines; it is also designed f0 Offer families peace of mind that their loved one is being weli cared and having an away "while they too benefit from a break from their resporiibilitieeniovable circumstances to introduce and impose a "no treats" policy would presen In these experience for our customers and would amount to an inappropriate and negative oppressive fetter on their expression of wishes and desires. iatwouid petetiada] to the purpose of the service and would undermine its function, Therefore; again; for these reasons, the introduction of a written mandatory 'no treats policy" would not appear to be an appropriate or a desirable development; nor does there be a need for additional first aid training for staff over and above that which appear to given as a matter of course (see below):. are already Eulfilling Lives Service This Service provides support to over 800 customers some of whom have more learning disabilities and Who need a high level of support. significant The focus of the service provided to these customers is to provide socially safe, fulfilling and enriching activities the dagtime Gervicde arcialcvideayable healthy Soctcirs oin buildings and facilities and through partnership working with over 20 Third Sector service provider organisations. Currently services are provided to customers from 23 specialist buildings and bases co- located inisports and community centres across Leeds. The aim of the Service isto maximise opportunities for social inclusion and to promote community access and participation, This service has recently undergone a modernisation programme to enable it to move from an old size fits all approach where services were provided at designated centres which were isolated from their wider communities and which were only accessed customers their families_ The Council now provides far more flexible personalised by and community bases being opened across Leedsorethin existegsacalieed secvicess Leifurew Centres, which provide services to all sectors of the such as Leisure are being refurbished and a new centre is buelcom lineniith thiddicoer existing buildings this modernisation programme , customers generally participate in smaller group activities over a wide and diverse range of bases across the City: Juet over half of the customers who access this Service live at home with family carers Therefore; as in the case of our respite customers; by definition; chee needs an theser customers do not necessitate a high level of first aidimedicalised training: Nor de fhe normal lives of our customers include treat" rules_ Setelatioaito the Areas of Concern specifically raised by the Coroner; the Councils position set out below is Many, family the for, "holiday caring free they during "one being "no

Ihe lack ofa written "No_Treats Policy" The ethos of the Councils Social Care Services is to provide in all cases the best and most appropriate person centred care that it can for each individual that it serves. The customers of the Learning Disability Community Support Service vastly divergent and highly individualised needs and wishes_ We aim to meet them all: To achieve this We have created besgolof highly personalised risk assessment tools and Individual Support Plans which are bespoke to each of our customers. Prior to entry into our Service: each customers individual needs are assessed in detail with chekuppost and assistance ofappropriate professionals such as (in the case of feeding and shoking risks) Dieticians and Speech and Language Therapists who advise euporeeherypesc of Suitable foods and in the optimal manner of preparation and presentation to our customers These assessments cover all aspects of our customers' individual needs, and lead to hee preparation of their Individual Assessments, and Individual Support Plans. We organise staff teams s0 that our staff work with small groups of customers on a consistent basis and are familiar with their individual needs, and are knowledgeable in how to appropriately meet and respond to them In the case of feeding, each customer who has a need for & modified diet has a "placemat" plan prepared for them; This placemat goes with customer on all and is therefore visible and in use at all times when consumption of food or drink is being planned and is taking place_ The Council notes the matter of concern that has been raised in relation to a lack of a written treats policy. However_ in the case of a customer who has been assessed as being at risk of choking due t0 an impaired ability to ingest & normal diet; the risk of chokingsi9pregented rt just by "treats but by all foods which are presented to that person in an unsuitable form, The Council therefore believes that the current practice that it has in place; Which addresses all foods that an individual is to be offered is & more appropriate measure to protectite customers from a choking risk The Council accepts and deeply regrets that Alison's death was contributed to by neglect ondheigartof a member of its care staff who failed to comply with the Individual Support Plan and Risk Assessment that had prepared for, and which was tailored to, Alison's needs; Alison's Individual Support Plan was created by care staff working in conjunction with_ appropriate specialist professionals It contained specific advice that Alison was at risk of choking and that the action necessary to manage that risk was to ensureohatherfood was liquidizedlfinely chopped before it was served to her; All risk assessments are kept under regular review In the case of Alison, all staff working with her were familiar with it The practice of the Learning Disability Community Support Service is that all new staff (whether they be agency or permanent staff) receive a fUli induction and training before working directly with customers: Having first read the care plans , all new staff are gradually introduced to the customers with whom will be working whilst alongside and shadowing established workers. In this way customer specific knowledge of each customer s individual care plans, risk assessmentsuandmeeds and gain insight and experience of best practice. Only after this process has taken place are new staff permitted to work directly with customers. Had Alison's well documented care plan been adhered to (as it always had been previously), this dreadful event would not have occurred. have Risk very the outings the fully been very they working they gain

First Aid Training Supperioesviceeriooedethe customers that are served by the Learning Support Service do not generally present with compleecand aditionai Disability Community is therefore no need for the service to engage the servicenc medical needs. There mentioned in the Coroners of "health support workers as report, The Service's customers do however suffer from range 0f cognitive impairments which can on occasions mean that and physical without adequate and appropriate could be at greater risk of suffering harm appropriate staff: customer supervision This risk Is assessed and met in determining Learning ratios On 20 April 2012, there were 61 customers usingthe needs Diseiidy Community Support Service at Horsforth Fereiling Centre, and their were being met by 20 staff Alison received care in her distregs_ who was fully trained in First Aid. a member of staff The Council provides staff with First Aid Training as part of its on-going apatinuing professional development The counges shach are providingaPeO9irar Aic iof and Fundamental First Aid. are First Aid in Work All new staff within the Learning Disability Community training on Fundamental First as part of their induction Support Service receive for the Fundamental First Aid (or Emergency First _ programme_ The course content Aid) course is as follows: Objectives by the end of the course you will be able to: Act safely, promptly and effectively in an erergency; Freat an unconscious casualty (including seizure) Prevent cross infection Perform effective Adult CPR Enderstand the differerces between Adult; Child and Baby CPR Recognise and treat the following: Choking; Bleeding; Shock The First Aid training regime is a programme. Both the First Aid at Work Furdamental First Aid training qualifications last foc 3 earseitershich and the renewed In the three years prior to Alison'8 death 26 members should be with having achieved of care staff were accredited 144 staff requisite standard in relation to the First_ at Work course, and were trained in Fundamental First Aid. In the 3 years since Alisong have been accredited following successful death; 68 staff 547 staff have successfully completion of the First Aid at Work course, and completed the Fundamental First Aid/Emergency First Aid coursec therefore believe that the Councils current training regime meets the Assistant Coroner expressed in her report; concern that the Einallya on behalf of the Council and the staff who worked with and cared for again express sincere and heartfelt condolences to Alison'8 Alison, wish to tragic loss. family and loved ones for her faithfully Secilon Head Civil Litigation they Lives from working Aid rolling they the Aid the Yours