Dear Jaqueline , Re: Mr Michael Terence Harman Thank you for your report dated 25" November 2014, please find our response below: Before detailing our proposed actions and timetable, have provided responses to some of the issues highlighted in the report: This is to provide further clarity about the service we offer and the circumstances surrounding Mr Harman's death Centra'8 Older Person's Support offer in North Norfolk Potential tenants are assessed for their eligibility to move into sheltered accommodation and have tenancy agreement directly with the landlord, in this case Victory Housing Trust People within sheltered housing have a arying degree of need and all are encouraged to be as independent as possible_ Often people's needs change over time but this does not automatically mean that their tenancy agreement would need to come to an end: Local authorities seek to support people in making their own choices and to maintain their preferred lifestyle. Increasingly; this means that people remain in their own homes for as iong as possible and that their support and care needs are met in their own home. The housing related support service provided by Centra involves two main elements; the welfare check and the face to face visit; The welfare check is usually completed remotely through the warden call system and is a brief check with the tenant to make sure they are well and to offer an opportunity to that person to request additional support Face to face support is arranged on an appointment basis with a defined purpose and outcome The role is to provide housing related support to tenants within the schemes: This can include things Iike supporting people to manage their money: maximise their income; make links to health and social care, signpost to other services,and to encourage mutual support by tenants The support coordinators travel between different sheltered schemes to provide this support and they do not remain static in one location: This' means that tenants are encouraged to request support as and when it is needed, rather than having the support coordinator seek them out to offer support: This is in accordance with the service specification as commissioned by Norfolk County Council; as well as promoting independence, choice and control amongst the tenants Circle Housing welcomes calls from Text Relay If calling from a textphone {NVESTPRS please dial the prefix 18001 and the number you wish to contact: Liriireli: 'rejiJleradin Enz"1n |an] Ihlee Nla 0307u24 Ir GenlnSTCSIC Raalslcte Obee: Cirake Hcuse &-a Hipltury Stalisn Fctl LonJ::Nt ASE' Ciak Cuc $1 d SuTP n 1(iiriny Registercd Charily Ha 1o7432 Fart of Cirle Ko-sing #HCLSGOi 4inja

Within the sheltered schemes including Mr Harman's flat is an emergency 'warden call system'. By pressing a call button or by pulling one of the emergency pull-cords in the flats and communal areas tenants have access to a call handler 24hrs The call handlers have access to personal information and contacts for every tenant within the sheltered scheme. The call handlers are trained to respond to emergencies by taking important information and raising an alert with the emergency services, the person's next of kin and during working hours with the support coordinators The call handlers also receivve non- emergency calls and raise alerts as appropriate and agreed with the individuals concerned Provision of personal care in the community is regulated by the Care Quality Commission and is employed to support people to remain in their own homes for as long as possible This provision depends o the person's needs and preferences and can include several visits a from care workers_ With the exception of people who are able and willing to pay for and organise their own care, the majority of care at home is managed through local authority adult care services. This includes the assessment of individuals requiring care_ against the Fair Access to Care Services eligibility criteria before the local authority commissions 'package of care' for that person_ The time frame from first contact with the local authority to receiving care is variable but not immediate. Norfolk County Council provides service called 'Norfolk Swift Response'_ This service is regulated by the CQC and can assist with getting up, washing, dressing and falls It is available for people who have an urgent;, unplanned need for care at home but who don't require the emergency services Response to concerns raised in the report Section 4; Clarification: At the inquest evidence was given that Centra Support Coordinator made referral to Norfolk Swift Response and requested that the service attend Mr Harman on 18h July 2014 to support him to manage his personal care_ Norfolk Swift Response declined to attend because Mr Harman's difficult situation was regarded as due to his use of alcohol rather than the result of an ongoing personal care need. was not able to directly support Mr Harman with his personal care as this is an activity regulated by the Care Quality Commission, The sheltered support service is not_regulated by the CQC and sO support with this activity is prohibited, Imade contact with Mr Harman's family to let them know about his difficulties_ Section 4: Clarification: 'a warden gave evidence that he later saw:Mr Harman'. The person who gave this evidence was actually a Housing Officer employed at the time by the landlord, Victory Housing Trust Section 5 (2): Clarification: 'Mr Harman_ was no longer suitable for independent living'. With regard to the Mental Capacily Act we believe that Mr Harman had capacity, and as such was fully able to make his own choices about his arrangements_ The local authority, medical practitioners and the support service would have no legal authority to remove him from his accommodation: Mr Harman had tenancy agreement between himself and the landlord (Victory Housing Trust). As already described, community care services are provided through the local authority to support people to remain in their own homes for as long as possible, as well as to support swift hospital discharges_ person may live in sheltered accommodation and receive housing related support, have 24hr warden call system and also be in receipt of a 'care package'_ The maximum amount of support referred to in the report, was only the housing related support element offered by Centra_ day: day living

Section 5 (3): Clarification: Centra's support service is service user led and therefore the review process requires the tenant to engage with a review: In this situation, an immediate review 'of' Mr Harman and his situation would have resulted in a referral to Norfolk First Response for immediate support; along with a referral to Norfolk Adult Care Services to request an assessment for care at home. It is likely that planned review 'with' Mr Harman would have resulted in the same recommendation. It is important to note that assessed for and receiving care at home would require Mr Harman's consent Evidence given at the inquest indicated that Mr Harman had previously declined a care at home service: Again, evidence was given at the inquest indicating that the immediate need was in fact referred to Norfolk First Response by Centra staff. The report does not appear to recognise that Mr Harman found himself in very difficult situation on the 18lh as a direct result of alcohol abuse and that this had been a previous pattern of behaviour: As such, an ongoing need requiring a referral for care at home may have been immediately evident_ The report does not appear to fully recognise that Mr Harman had access to the warden call system for emergency assistance but did not make use of it It would have been helpful to have had representative from Norfolk County Council Adult Care Services present to give evidence describing the sheltered accommodation, the support service; to give history of Mr Harman's previous care at home service and t0 elaborate on why the referral made by Centra to Norfolk First Response was not accepted Actions and timetable After reviewing the concerns raised in your report; the following actions have been planned / taken: Acitron Wlho Wiejn loele Full internal review of Locality NovlDec Completed Review has been working practices in the Business carried out and recommendations service to be carried out. Manager presented to the Regional Business Manager:_ Full review of welfare checks Locality NovlDec Completed Review has been and warden call response Business carried out and recommendations process: Manager presented to the Regional Business Manager Discuss outcome of welfare January In progress discussion is check and warden call ongoing with the Service review with Service Commissioner from Norfolk Commissioner. County Council to consider alternative ways of carrying out welfare checks so that support coordinators can focus more on support related tasks and face to face contact; Draw up and roll out local Locality January Completed please see attached guidance protocols for Business guidance document. (1) Reporting of Manager accidents , incidents and near misses (2) Follow up with a service user when an being fully July not

accident, incident or near miss has been reported (3) Making onward referrals (4) When to undertake scheduled and unscheduled reviews Audit schedule developed to Team End of To be completed check understanding and Manager January compliance with new local guidance hope this response provides assurances that we are appropriate steps to ensure the continued safety and wellbeing of any person that uses our services. We take our responsibilities around health and wellbeing very seriously and welcome all feedback and suggestions for improvements in our working practices We have taken note of your concerns and are taking appropriate actions to ensure that the risk of similar incident occurring are minimised. If you any further questions or require any clarification please do not hesitate to let me know: