8 Jan 2026 Jean Alice WALDRON · Prevention of Future Deaths report Worcestershire
View report summary
Concerns raised 1
Lack of adequate training on the limits of care carers are able to provide View source
This report raised 1 other concern. They are not shown here because they do not form part of this recurring concern.
×
AI-generated summary
Jean Alice WALDRON · Prevention of Future Deaths report
This summary was generated using AI from the published report. Please read the original report for the complete account.
Report summary
Jean Waldron had a long-standing cervical spinal cord injury, vascular dementia and a sacral pressure ulcer, later developed a chest infection, and died at home in Worcester on 12 March 2025. Concerns were raised that a Team Leader carer removed wound dressings and attempted to clean the pressure sore despite instructions that carers were not licensed to provide wound care; the Tissue Viability Nurse said that using gauze was inappropriate and could have caused further complications. The report also questioned whether agency carers had received adequate training about the limits of their care and following specialist clinical advice.
Read the report on judiciary.uk
× Source evidence
How this individual concern was interpreted PFD Monitor created a concise, searchable interpretation from the report wording shown below.
PFD Monitor interpretation Lack of adequate training on the limits of care carers are able to provide
Wider context from the report “In her evidence at the inquest a carer from your agency, who was a Team Leader, gave evidence that:
(a) she had read and understood an email from the District Nurse Clinical Lead, dated 15.1.25, which made clear that carers should not provide any care in relation to Mrs. Waldron's pressure sore as they did not have the correct licence to provide wound care; and
(b) despite that clear instruction, she had on 3 separate occasions thereafter removed soiled wound dressings from the pressure sore and attempted to clean the wound with saline and gauze because she felt that it was in the deceased's "best interests" so to do.
The lead Tissue Viability Nurse who gave evidence at the inquest said that the use of gauze was inappropriate and would have led to further adverse complications with the pressure sore.
It is particularly concerning that a carer who was a Team Leader acted in the way described, and suggests that carers employed by your agency may not have received adequate training about:
(a) the limits of the care which they are able to provide ; and
(b) the need to accept and follow advice given by specialist doctors and nurses at all times.
” Source location Jean Alice WALDRON · Prevention of Future Deaths report
Open source report
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Reinforce guidance that wound care and pressure sore management are outside carers’ scope and must be undertaken only by qualified persons.
Verbatim wording from the response “1. Scope-of-Practice Reinforcement
All staff have received reinforced guidance clarifying that wound care and pressure sore management are outside the scope of carer practice and must only be undertaken by appropriately qualified persons.” Source location Response from Ignite Health and Homecare Services
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Issue formal reminders requiring staff to escalate clinical concerns to district nursing or medical professionals and not act beyond authorised duties.
Verbatim wording from the response “2. Escalation and Accountability Reminder
Formal reminders have been issued confirming that where clinical concerns arise, staff must escalate to district nursing or medical professionals and must not act independently outside authorised duties.” Source location Response from Ignite Health and Homecare Services
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Review supervision and audit processes to strengthen oversight of adherence to scope-of-practice boundaries.
Verbatim wording from the response “3. Governance Oversight
Existing supervision and audit processes have been reviewed to ensure continued oversight of adherence to scope-of-practice boundaries.” Source location Response from Ignite Health and Homecare Services
Open published response
×
Source evidence
How this respondent position was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation The incidents reflected individual judgment contrary to policy, training and instructions, not a deficiency in carers’ understanding or the agency’s systems and governance.
Verbatim wording from the response “The Team Leader who gave evidence confirmed that she had read and understood this instruction. This demonstrates that the agency’s communication, governance, and escalation systems were effective and that staff were aware of the limits of care they were permitted to provide.” Source location Response from Ignite Health and Homecare Services
Open published response
26 Nov 2025 Celia Marion PHILLIPS · Prevention of Future Deaths report Birmingham and Solihull
View report summary
Concerns raised 1
Lack of carer training on pressure sores, skin assessment or repositioning View source
This report raised 2 other concerns. They are not shown here because they do not form part of this recurring concern.
Stated actions An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised. 2
Inspire You Care Ltd
Provide further training in wound prevention.
View source
Inspire You Care Ltd
Conduct competency spot checks of staff after the training period.
View source
×
AI-generated summary
Celia Marion PHILLIPS · Prevention of Future Deaths report
This summary was generated using AI from the published report. Please read the original report for the complete account.
Report summary
Celia Marion PHILLIPS had a complex medical history and was bed bound, receiving care at home four times a day. She was admitted to hospital on 27 April 2025 with a probable chest infection, acute kidney injury and dehydration; a fractured ventriculo-peritoneal shunt had eroded through the skin and was protruding. She died on 1 May 2025 from multiple organ failure and sepsis of unknown origin, with the malfunctioning shunt contributing to her neurological decline and predisposing her to infection and dehydration. Concerns included a lack of evidence that she was repositioned or that carers had received training on pressure sores, skin assessment and repositioning, and she was found to have a deep tissue injury and a grade 1 pressure sore on admission.
Read the report on judiciary.uk
× Source evidence
How this individual concern was interpreted PFD Monitor created a concise, searchable interpretation from the report wording shown below.
PFD Monitor interpretation Lack of carer training on pressure sores, skin assessment or repositioning
Wider context from the report “1. The deceased was bed bound.
2. On the 12th March the deceased's GP documented that she had pressure sores and stressed the importance of frequent repositioning, noting that she had carers who attended four times a day.
3. In both written, oral and documentary evidence provided by the carers there was no indication that repositioning had been undertaken; that there was any understanding of the need for repositioning to mitigate against the development of pressure sores; or that there had been training on pressure scores, skin assessment or re-positioning .
4. Whilst not causative of or contributory to death when admitted to hospital on the 27th April 2025 it was noted that the deceased had a DTI and a grade 1 pressure sore.
” Source location Celia Marion PHILLIPS · Prevention of Future Deaths report
Open source report
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Provide further training in wound prevention.
Verbatim wording from the response “– Team managers will meet with all staff individually in their supervision and discuss the importance of detailed and accurate daily recording.
– Staff will undergo refresher training on Record Keeping and Communication.
– Staff will also undertake further training in Wound Prevention.
– These trainings will be completed within a four-week (19th January 2026 – 15th February 2026) timeframe and then care coordinators will carry out competency spot checks on the staff members.
– Management team will also look into working with digital recording provider (Access Group) and set up options of skin check / repositioning for clients where needed as a check in item on the daily recording element.” Source location Response from Inspire You Care Ltd
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Conduct competency spot checks of staff after the training period.
Verbatim wording from the response “– Team managers will meet with all staff individually in their supervision and discuss the importance of detailed and accurate daily recording.
– Staff will undergo refresher training on Record Keeping and Communication.
– Staff will also undertake further training in Wound Prevention.
– These trainings will be completed within a four-week (19th January 2026 – 15th February 2026) timeframe and then care coordinators will carry out competency spot checks on the staff members.
– Management team will also look into working with digital recording provider (Access Group) and set up options of skin check / repositioning for clients where needed as a check in item on the daily recording element.” Source location Response from Inspire You Care Ltd
Open published response
×
Source evidence
How this respondent position was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Staff state that they understood the importance of repositioning bed-bound service users and had appropriate skills or training to support Celia.
Verbatim wording from the response “– Carers informed the management team that they were aware Celia was bed bound as they read her care plan. Carers said they had the appropriate skills/training to support her whilst she was in bed. This includes the importance of repositioning her at an appropriate interval when they attended their care calls. They also understood that if there were any concerns around Celia skin then this should be immediately informed to the district nurses.
– When staff were asked that it was not reported in the daily logs that Celia was repositioned, staff admitted that this was their failing part due to poor record keeping and not mentioning this important information in the daily notes.” Source location Response from Inspire You Care Ltd
Open published response
18 Nov 2025 Jack Richard BROWN · Prevention of Future Deaths report Northamptonshire
View report summary
Concerns raised 1
Failure of care homes to ensure agency carers' suitability, experience and training View source
This report raised 2 other concerns. They are not shown here because they do not form part of this recurring concern.
×
AI-generated summary
Jack Richard BROWN · Prevention of Future Deaths report
This summary was generated using AI from the published report. Please read the original report for the complete account.
Report summary
Jack Richard BROWN, aged 86, was found unresponsive and died at a care home on 26 January 2023 after remaining asleep on a toilet overnight; the post-mortem examination concluded that he died due to ischemic heart disease. The report raised concerns that care agencies supplying staff to care and nursing homes are not required to register with or be regulated by the CQC or another body, creating risks around recruitment, suitability and training of agency carers.
Read the report on judiciary.uk
× Source evidence
How this individual concern was interpreted PFD Monitor created a concise, searchable interpretation from the report wording shown below.
PFD Monitor interpretation Failure of care homes to ensure agency carers' suitability, experience and training
Wider context from the report “At the inquest the court heard evidence that care agencies who provide agency care staff to care / nursing homes do not need to register with the CQC and are not regulated by any other body. The activities of such agencies are therefore not inspected or checked to ensure that they have rigorous recruitment processes and there is no one to report matters to when a concern is identified.
This gives rise to a concern as care homes may rely on agencies to vet agency carers and have minimal input into suitability and training for the role . This creates a risk that agency care staff, who may be wholly unsuitable for the role, are providing care to vulnerable people without basic checks as to experience and suitability . This places service users at risk of harm and gives rise to a risk that future deaths could occur.
” Source location Jack Richard BROWN · Prevention of Future Deaths report
Open source report
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Revise and expand the Care Workforce Pathway to provide a national structure for adult social care knowledge, skills, values, behaviours and progression.
Verbatim wording from the response “Further to those regulatory safeguards, the department is committed to enhancing the skills of staff working in adult social care, including those employed by agencies. It is vital to ensure that the care provided is of good quality, fair, personalised, and accessible. The department is supporting the professionalisation of the workforce through a range of activities which agencies can access for their employees. We recently revised and expanded the Care Workforce Pathway, the first national career structure for adult social care. This sets out the knowledge, skills, values, and behaviours needed to work in the sector and provides a framework for progression and development.” Source location Response from Department for Health and Social Care
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Launch the Adult Social Care Learning and Development Support Scheme to fund eligible care staff courses and qualifications, including the Level 2 Adult Social Care Certificate.
Verbatim wording from the response “The department also launched the Adult Social Care Learning and Development Support Scheme in September 2024, backed by up to £12 million this financial year for eligible care staff to undertake courses and qualifications, including the new Level 2 Adult Social Care Certificate. Developed from the Care Certificate standards, the Level 2 Adult Social Care” Source location Response from Department for Health and Social Care
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Launch the Quality Assured Care Learning Service to help individuals and employers identify trusted sector learning and development opportunities.
Verbatim wording from the response “Certificate has been designed to support people in care roles to have the most up to date knowledge and baseline skills required to support people to succeed in their roles. To ensure training undertaken is of good quality, we also launched the Quality Assured Care Learning Service which supports individuals and employers to easily identify trusted learning and development opportunities which meet the needs of the sector.” Source location Response from Department for Health and Social Care
Open published response
×
Source evidence
How this respondent position was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Regulated care providers, rather than employment agencies, are responsible for ensuring agency staff are suitably experienced, competent and recruited safely.
Verbatim wording from the response “Care homes and nursing homes do typically carry out regulated activity and therefore are registered with CQC. CQC requires all health and social care providers registered with them to deploy enough suitably qualified, competent and experienced staff (including both registered and unregistered professionals) to enable them to meet all other regulatory requirements described in Regulation 18 Staffing of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These regulations apply to providers who recruit care staff via employment agencies. It is the responsibility of the regulated provider to ensure robust and safe recruitment practices are in place, and to make sure that all staff, including agency staff, are suitably experienced, competent and able to carry out their role.” Source location Response from Department for Health and Social Care
Open published response
×
Source evidence
How this respondent position was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Existing CQC registration requirements, staffing duties, training, supervision and regulatory action provide safeguards for agency staff suitability and competence.
Verbatim wording from the response “Care homes and nursing homes do typically carry out regulated activity and therefore are registered with CQC. CQC requires all health and social care providers registered with them to deploy enough suitably qualified, competent and experienced staff (including both registered and unregistered professionals) to enable them to meet all other regulatory requirements described in Regulation 18 Staffing of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These regulations apply to providers who recruit care staff via employment agencies. It is the responsibility of the regulated provider to ensure robust and safe recruitment practices are in place, and to make sure that all staff, including agency staff, are suitably experienced, competent and able to carry out their role.” Source location Response from Department for Health and Social Care
Open published response
22 Apr 2024 Angela Marietta Carpos · Prevention of Future Deaths report Inner North London
View report summary
Concerns raised 1
Lack of clarity about carers’ aspiration pneumonia training View source
This report raised 3 other concerns. They are not shown here because they do not form part of this recurring concern.
Stated actions An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised. 4
MiHomecare Limited
Launch redesigned annual Care Professional Development training covering choking, aspiration and related care-safety topics.
View source
MiHomecare Limited
Update induction training with additional clarity on aspiration and choking.
View source
MiHomecare Limited
Launch the further updated refresher training with additional clarity on aspiration and choking.
View source
MiHomecare Limited
Update themed choking supervision to include aspiration and aspiration pneumonia, and release the revised version.
View source See 1 more action
×
AI-generated summary
Angela Marietta Carpos · Prevention of Future Deaths report
This summary was generated using AI from the published report. Please read the original report for the complete account.
Report summary
Angela Marietta Carpos collapsed while eating dinner on 25 December 2022 and later died in hospital after respiratory arrest, aspiration-related hypoxia and cardiac arrest. The report raised concerns that carers were unable to recognise aspiration pneumonia and were unclear about their training, including its content and frequency. A witness was also unable to say what qualifications the company’s trainers had or what the company’s policies contained.
Read the report on judiciary.uk
× Source evidence
How this individual concern was interpreted PFD Monitor created a concise, searchable interpretation from the report wording shown below.
PFD Monitor interpretation Lack of clarity about carers’ aspiration pneumonia training
Wider context from the report “In Angela’s case, her daughter recognised very quickly that there was a problem and called an ambulance immediately. However, the carers (who knew Angela well, and cared for her with diligence) were unable to recognise aspiration pneumonia and were unclear about whether they had received any training on it, were unclear about what training they do receive, or how often they receive it .
The PFD witness was unable to say what qualifications the company’s trainers have and did not know the contents of the company’s policies.
” Source location Angela Marietta Carpos · Prevention of Future Deaths report
Open source report
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Launch redesigned annual Care Professional Development training covering choking, aspiration and related care-safety topics.
Verbatim wording from the response “2.5. In terms of refresher training, our revised Care Professional Development training (CPD training) has just been launched. This annual update training has been redesigned and now includes relevant updates alongside scenarios to enhance understanding around the impact and consequences of decisions made by our care staff. It looks to expand knowledge as our care workers progress and to bring our training to life, linking these to outcomes for people under our care. This is an online modular course covering the following topics: Health and Safety; First Aid Awareness (which covers choking and aspiration); Moving and Assisting; Infection Prevention and control; Food Safety; Medication administration; Handling Information (GDPR); Record Keeping and internal communications; and Dementia Awareness.” Source location Response from Mi Homecare
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Update induction training with additional clarity on aspiration and choking.
Verbatim wording from the response “4.3. CCH Group had also updated its induction and refresher training from October 2022 (starting with the induction training and then moving to the refresher training) to include more detail on choking and aspiration. This version of the training was completed by the two care workers on shift on the evening on 25 December 2022, in June and August 2023. Our training on choking and aspiration has since been further updated and launched to include additional clarity around aspiration (again, starting with the induction training and then moving to the refresher training, the updated version of which is due to go live this week). I have appended a printout of the materials from the most recently updated [induction / refresher] training at Appendix 2 to demonstrate the topics covered.” Source location Response from Mi Homecare
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Launch the further updated refresher training with additional clarity on aspiration and choking.
Verbatim wording from the response “4.3. CCH Group had also updated its induction and refresher training from October 2022 (starting with the induction training and then moving to the refresher training) to include more detail on choking and aspiration. This version of the training was completed by the two care workers on shift on the evening on 25 December 2022, in June and August 2023. Our training on choking and aspiration has since been further updated and launched to include additional clarity around aspiration (again, starting with the induction training and then moving to the refresher training, the updated version of which is due to go live this week). I have appended a printout of the materials from the most recently updated [induction / refresher] training at Appendix 2 to demonstrate the topics covered.” Source location Response from Mi Homecare
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Update themed choking supervision to include aspiration and aspiration pneumonia, and release the revised version.
Verbatim wording from the response “2.6. Care workers receive supervisions at their relevant Branch Office every 3 months. We have a specific type of supervision called a themed supervision – one of the available themed supervisions covers choking (and is in the process of being updated to cover aspiration / aspiration pneumonia – see paragraph 4.4.1). In a themed supervision, there will be scenarios that care workers need to answer and then Branch Office staff will discuss the answers with them. Staff can raise their concerns regarding a client in the supervision as well. They will be provided with clear and accurate guidance.” Source location Response from Mi Homecare
Open published response
8 Mar 2024 Rose Mary Hollingworth · Prevention of Future Deaths report Inner North London
View report summary
Concerns raised 1
Failure to provide suitably trained, experienced and competent carers View source
This report raised 3 other concerns. They are not shown here because they do not form part of this recurring concern.
Linked responses
Care Quality Commission HomeDot Care
Stated actions An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised. 3
HomeDot Care
Strengthen recruitment and induction through Care Certificate completion, orientation, induction, shadowing, supervision, competency sign-off and refresher training.
View source
HomeDot Care
Provide specialist training for staff in complex care needs, including stoma care, tracheostomy, epilepsy, PEG feeding, mental health, autism, suctioning and dysphagia.
View source
HomeDot Care
Establish structured supervision and monitoring of carers through early supervision, electronic attendance checks, care-note audits, training sign-off and response-to-concern meetings.
View source
×
AI-generated summary
Rose Mary Hollingworth · Prevention of Future Deaths report
This summary was generated using AI from the published report. Please read the original report for the complete account.
Report summary
Rose Mary Hollingworth, a frail woman with significant co-morbidities, was found unresponsive at home on 3 January 2022 after a carer left without carrying out welfare checks or providing care. She was admitted to hospital and died the following day from a spontaneous intracerebral haemorrhage. The concerns included failures to provide suitably trained and competent carers, supervise and manage carers, maintain an accurate care and support plan, and monitor the care agency.
Read the report on judiciary.uk
× Source evidence
How this individual concern was interpreted PFD Monitor created a concise, searchable interpretation from the report wording shown below.
PFD Monitor interpretation Failure to provide suitably trained, experienced and competent carers
Wider context from the report “(1) There was a failure to provide suitably trained, experienced and competent carers for a vulnerable person dependent on a package of care.
” Source location Rose Mary Hollingworth · Prevention of Future Deaths report
Open source report
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Strengthen recruitment and induction through Care Certificate completion, orientation, induction, shadowing, supervision, competency sign-off and refresher training.
Verbatim wording from the response “As a standard ongoing practice, we now ensure that our recruitment and training process covers the following:” Source location Response from HomeDot Care
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Provide specialist training for staff in complex care needs, including stoma care, tracheostomy, epilepsy, PEG feeding, mental health, autism, suctioning and dysphagia.
Verbatim wording from the response “• We provide specialist training for our staff such as Stoma Care and Tracheostomy, Epilepsy with Buccal administration, Peg Feeding, Mental Health, Mental Health First Aider, Learning Disabilities and Autism, Oral Suctioning and Dysphagia, etc.” Source location Response from HomeDot Care
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Establish structured supervision and monitoring of carers through early supervision, electronic attendance checks, care-note audits, training sign-off and response-to-concern meetings.
Verbatim wording from the response “The following is now in place:” Source location Response from HomeDot Care
Open published response
×
Source evidence
How this respondent position was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation The organisation considers that the carer received training in accordance with its policies and had prior care experience.
Verbatim wording from the response “There was a failure to provide suitably trained, experienced and competent carers for a vulnerable person depending on the package of care” Source location Response from HomeDot Care
Open published response
×
Source evidence
How this respondent position was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation No evidence was found that the concerns identified in the prevention of future death report remain.
Verbatim wording from the response “Given the action already taken by the Commission, we are reassured that HomeDotCare Limited have responded appropriately in response to the death of Rose Hollingworth. We have not seen evidence to suggest the concerns mentioned in section 5 of the regulation 28 report remain.” Source location Response from Care Quality Commission
Open published response
13 Mar 2023 Gunapathyammah Ranganathan · Prevention of Future Deaths report West London
View report summary
Concerns raised 1
Lack of adequate training and shadowing for new carers View source
This report raised 1 other concern. They are not shown here because they do not form part of this recurring concern.
Linked response
Lean on Me Community Care Services Ltd
Stated actions An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised. 12
Lean on Me Community Care Services Ltd
Consider and implement new staff training and assessment systems.
View source
Lean on Me Community Care Services Ltd
Add safe Zimmer-frame transfers and emergency responses to moving-and-handling knowledge tests.
View source
Lean on Me Community Care Services Ltd
Develop and implement policies and procedures covering shadowing records and competency observations.
View source
Lean on Me Community Care Services Ltd
Implement ongoing quality monitoring of staff training.
View source
Lean on Me Community Care Services Ltd
Redevelop senior-staff training, including the new-carer manual-handling competency test.
View source
Lean on Me Community Care Services Ltd
Source staff training from a vetted preferred provider aligned with Skills for Care and CQC standards.
View source
Lean on Me Community Care Services Ltd
Require vetted new staff and management to complete Level 1 and Level 2 induction training and follow the service’s policies and procedures.
View source
Lean on Me Community Care Services Ltd
Provide strength-based and train-the-trainer courses so supervisory and management staff can support field care workers.
View source
Lean on Me Community Care Services Ltd
Recruit seven experienced management personnel, including field care supervisors.
View source
Lean on Me Community Care Services Ltd
Continue recruiting care workers and field supervisors to provide competent field shadowing and performance appraisal.
View source
Lean on Me Community Care Services Ltd
Support care workers without RQF qualifications to enrol on RQF courses.
View source
Lean on Me Community Care Services Ltd
Use the new field-shadowing form to document shadowing activity.
View source See 9 more actions
×
AI-generated summary
Gunapathyammah Ranganathan · Prevention of Future Deaths report
This summary was generated using AI from the published report. Please read the original report for the complete account.
Report summary
Gunapathyammah Ranganathan, who was elderly and frail, fell backwards while walking to the bathroom with a Zimmer frame during a care visit on 11 July 2021. She sustained a severe head injury and died in hospital on 14 July 2021. The report raised concerns that the new carer lacked adequate training and shadowing experience, and that Mrs Ranganathan was left unattended despite requiring direct supervision while mobilising.
Read the report on judiciary.uk
× Source evidence
How this individual concern was interpreted PFD Monitor created a concise, searchable interpretation from the report wording shown below.
PFD Monitor interpretation Lack of adequate training and shadowing for new carers
Wider context from the report “There was little evidence before the court that the new carer had received any or any adequate training or shadowing experience. The new carer could not be deemed to be competent at mobilising a service user with a Zimmer frame as there was no evidence that she had done so.
Lean on Me care agency was said to not currently be trading, but the company and web site remain live and therefore could recommence work in the care sector. The court requires confirmation of training schedules and policies, together with shadowing policies for new carers with no previous experience or training and confirmation that steps have been taken to avoid the situation that arose in this case, when a service user who should have been under direct supervision at all times when mobilising was unattended, and sustained a fatal head injury when she fell.
” Source location Gunapathyammah Ranganathan · Prevention of Future Deaths report
Open source report
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Consider and implement new staff training and assessment systems.
Verbatim wording from the response “• New training and assessment systems will be considered and implemented.” Source location Response from Lean on Me Care Agency
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Add safe Zimmer-frame transfers and emergency responses to moving-and-handling knowledge tests.
Verbatim wording from the response “• Moving and handling component to specifically include in testing knowledge of safe Zimmer frame transfers, and how to respond to emergencies.” Source location Response from Lean on Me Care Agency
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Develop and implement policies and procedures covering shadowing records and competency observations.
Verbatim wording from the response “• New policies and procedures to be developed, including records for shadowing and competency observations.” Source location Response from Lean on Me Care Agency
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Implement ongoing quality monitoring of staff training.
Verbatim wording from the response “• An ongoing quality monitoring of training is to be implemented.” Source location Response from Lean on Me Care Agency
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Redevelop senior-staff training, including the new-carer manual-handling competency test.
Verbatim wording from the response “• Senior staff training in all areas to be redeveloped, including importance of “new carer test” in Manual Handling.” Source location Response from Lean on Me Care Agency
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Source staff training from a vetted preferred provider aligned with Skills for Care and CQC standards.
Verbatim wording from the response “In future, all our staff training needs will be sourced out to a Training Agency that has been suitably vetted by my Local Authority as their preferred training providers, so that the training needs of Lean on Me are fully in line with Skills for Care and CQC Standards of good practice.” Source location Response from Lean on Me Care Agency
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Require vetted new staff and management to complete Level 1 and Level 2 induction training and follow the service’s policies and procedures.
Verbatim wording from the response “You will also notice a breakdown of the Health and Social Care training courses which I have identified to be beneficial to all Lean On Me care workers, including the Management Team; regardless of their previous experience, qualifications acquired in care or in other professions. All applicants who have been successfully vetted and who have accepted our offer of employment, must attend all grassroots training courses Level 1 and Level 2 Induction Training. All staff must work within Lean On Me’s Policies and Procedures guidelines, which are in line with CQC standards of good practice, at office level and in the field.” Source location Response from Lean on Me Care Agency
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Provide strength-based and train-the-trainer courses so supervisory and management staff can support field care workers.
Verbatim wording from the response “Coordinators, Quality assurance officers and Field care workers, must all, again, undergo the training courses starting at level 1 Induction training, and level 2 Care Award. This will be followed by further training in “STRENGTH BASED” COURSES, including “TRAIN THE TRAINER”, so that our field supervisors, care coordinators, managers, quality assurance officers all have the knowledge required to support field care workers when they require additional support from the office staff.” Source location Response from Lean on Me Care Agency
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Recruit seven experienced management personnel, including field care supervisors.
Verbatim wording from the response “I have recently recruited 7 management personnel. The 7 applicants already have acquired more than 5 years’ experience working in Health and Social Care. One has Leadership and Management qualifications in care, and has been earmarked as a future Manager, because she has worked as a Registered Manager for a large Care provider in the past. Another possible manager has Adult Nursing qualifications from Massachusetts USA, and is currently doing UK NMC adaptation. He has also acquired other qualifications in the USA: a Bachelor’s degree in public health and an NBA master’s degree in business administration. I have two field care supervisors with over 10-years previous care experience, including specialist training courses acquired when they worked in other Care provider organisations.” Source location Response from Lean on Me Care Agency
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Continue recruiting care workers and field supervisors to provide competent field shadowing and performance appraisal.
Verbatim wording from the response “This being said, we are still recruiting all who are interested to work with Lean on Me - Care workers and Field Care Supervisors. Our goal is to have a good number of field care supervisors who are competent to work alongside care workers during their field shadowing training, so that they can appraise their performance in the field and decide if the new care worker is fit to” Source location Response from Lean on Me Care Agency
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Support care workers without RQF qualifications to enrol on RQF courses.
Verbatim wording from the response “continue as a care worker or not. For those care workers who have not acquired RQF, they too will be supported to enrol in RQF courses.” Source location Response from Lean on Me Care Agency
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Use the new field-shadowing form to document shadowing activity.
Verbatim wording from the response “As we do not have any service users whose care needs involve regulation 9 Regulated Activities. we are attaching to you a blank copy of our new FIELD SHADOWING FORM.” Source location Response from Lean on Me Care Agency
Open published response
Concerns raised 2
Lack of training and skills to respond to a medical emergency View source Lack of training and skills to identify a medical emergency View source
Linked response
Trinity Homecare Group Ltd
Stated actions An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised. 4
Trinity Homecare Group Ltd
Send carers guidance on when to call emergency and non-emergency health services.
View source
Trinity Homecare Group Ltd
Incorporate emergency-call examples into induction and refresher training.
View source
Trinity Homecare Group Ltd
Enhance spot checks and conduct field monitoring to test carers’ knowledge of emergency procedures.
View source
Trinity Homecare Group Ltd
Introduce an emergency and unexpected death of a client policy for the care delivery team.
View source See 1 more action
×
AI-generated summary
Barbara PROUDLOVE · Prevention of Future Deaths report
This summary was generated using AI from the published report. Please read the original report for the complete account.
Report summary
Barbara PROUDLOVE died on 4 July 2020 at Southampton General Hospital after developing pneumonia in consequence of cardiac failure and dementia. Elevated morphine and lorazepam levels caused unconsciousness and contributed to her death, and there was a delay in summoning medical assistance. The principal concern was that the carer did not identify the medical emergency promptly and lacked the necessary training, skills and understanding to respond appropriately.
Read the report on judiciary.uk
× Source evidence
How this individual concern was interpreted PFD Monitor created a concise, searchable interpretation from the report wording shown below.
PFD Monitor interpretation Lack of training and skills to respond to a medical emergency
Wider context from the report “The Berkeley Home Health carer did not identify that the deceased was unconscious in good time; there was delay by the carer in summoning medical assistance .
The evidence of the carer demonstrated a lack of training, skills and understanding in being able to reasonably identify a medical emergency and how to respond to a medical emergency .
My concern is that such carers lack the necessary training and skills when tasked with caring for others in the same position as the deceased.
” Source location Barbara PROUDLOVE · Prevention of Future Deaths report
Open source report × Source evidence
How this individual concern was interpreted PFD Monitor created a concise, searchable interpretation from the report wording shown below.
PFD Monitor interpretation Lack of training and skills to identify a medical emergency
Wider context from the report “The Berkeley Home Health carer did not identify that the deceased was unconscious in good time ; there was delay by the carer in summoning medical assistance.
The evidence of the carer demonstrated a lack of training, skills and understanding in being able to reasonably identify a medical emergency and how to respond to a medical emergency.
My concern is that such carers lack the necessary training and skills when tasked with caring for others in the same position as the deceased.
” Source location Barbara PROUDLOVE · Prevention of Future Deaths report
Open source report
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Send carers guidance on when to call emergency and non-emergency health services.
Verbatim wording from the response “Carer Communication
Due to the nature of the concerns within the Regulation 28 all carers have been sent communications and guidance on when to call 999 in emergency situations and when to contact 111. Examples of these will be incorporated in our induction and refresher training and delivered by our in-house training team, who have been briefed on the incident to ensure the topic is trained and discussed to a point where all new starters are clear on the procedure. We have enhanced our spot check process and monitoring in the field will take place by our Field Care Supervisors and Care Managers to continue testing knowledge outside of a training room environment. An emergency and unexpected death of a client policy has been introduced to the care delivery team.” Source location Response from Berkeley Home Health
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Incorporate emergency-call examples into induction and refresher training.
Verbatim wording from the response “Carer Communication
Due to the nature of the concerns within the Regulation 28 all carers have been sent communications and guidance on when to call 999 in emergency situations and when to contact 111. Examples of these will be incorporated in our induction and refresher training and delivered by our in-house training team, who have been briefed on the incident to ensure the topic is trained and discussed to a point where all new starters are clear on the procedure. We have enhanced our spot check process and monitoring in the field will take place by our Field Care Supervisors and Care Managers to continue testing knowledge outside of a training room environment. An emergency and unexpected death of a client policy has been introduced to the care delivery team.” Source location Response from Berkeley Home Health
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Enhance spot checks and conduct field monitoring to test carers’ knowledge of emergency procedures.
Verbatim wording from the response “Carer Communication
Due to the nature of the concerns within the Regulation 28 all carers have been sent communications and guidance on when to call 999 in emergency situations and when to contact 111. Examples of these will be incorporated in our induction and refresher training and delivered by our in-house training team, who have been briefed on the incident to ensure the topic is trained and discussed to a point where all new starters are clear on the procedure. We have enhanced our spot check process and monitoring in the field will take place by our Field Care Supervisors and Care Managers to continue testing knowledge outside of a training room environment. An emergency and unexpected death of a client policy has been introduced to the care delivery team.” Source location Response from Berkeley Home Health
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Introduce an emergency and unexpected death of a client policy for the care delivery team.
Verbatim wording from the response “Carer Communication
Due to the nature of the concerns within the Regulation 28 all carers have been sent communications and guidance on when to call 999 in emergency situations and when to contact 111. Examples of these will be incorporated in our induction and refresher training and delivered by our in-house training team, who have been briefed on the incident to ensure the topic is trained and discussed to a point where all new starters are clear on the procedure. We have enhanced our spot check process and monitoring in the field will take place by our Field Care Supervisors and Care Managers to continue testing knowledge outside of a training room environment. An emergency and unexpected death of a client policy has been introduced to the care delivery team.” Source location Response from Berkeley Home Health
Open published response
×
Source evidence
How this respondent position was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation The incident is considered isolated, limiting the basis for further responsive safety work.
Verbatim wording from the response “The Trinity Group is committed to ensuring the health and safety of employees and clients and by continuous improvement in our health and safety and environment standards. I hope you find our actions satisfactory; we strongly believe this is an isolated incident and we have taken relevant action.” Source location Response from Berkeley Home Health
Open published response
14 Jan 2020 John David Long · Prevention of Future Deaths report London Inner (West)
View report summary
Concerns raised 1
Failure to implement, administer and communicate 1:1 care training View source
This report raised 3 other concerns. They are not shown here because they do not form part of this recurring concern.
No linked response statements No respondent-stated action or position is linked to these concerns in the published data.
×
AI-generated summary
John David Long · Prevention of Future Deaths report
This summary was generated using AI from the published report. Please read the original report for the complete account.
Report summary
John David Long suffered an unwitnessed fall from his bed in Benjamin Weir Ward at St. George’s Hospital on 4 May 2019, sustaining a head injury that led to his death. The concerns identified relate to the design and suitability of bed rails, the definition and administration of one-to-one care, provision of breaks without leaving the patient alone, and training for one-to-one care.
Read the report on judiciary.uk
× Source evidence
How this individual concern was interpreted PFD Monitor created a concise, searchable interpretation from the report wording shown below.
PFD Monitor interpretation Failure to implement, administer and communicate 1:1 care training
Wider context from the report “3.A review is required on how training of 1: 1 (one to one) care is implemented
And administered on a hospital ward and also how such training is communicated to nurses and Carers .
” Source location John David Long · Prevention of Future Deaths report
Open source report
13 Feb 2019 Sophie Bennett · Prevention of Future Deaths report West London
View report summary
Concerns raised 1
Untrained and unqualified care staff View source
This report raised 19 other concerns. They are not shown here because they do not form part of this recurring concern.
No linked response statements No respondent-stated action or position is linked to these concerns in the published data.
×
AI-generated summary
Sophie Bennett · Prevention of Future Deaths report
This summary was generated using AI from the published report. Please read the original report for the complete account.
Report summary
Sophie Elizabeth Alice Bennett died at Kingston Hospital from injuries caused by applying a ligature at Lancaster Lodge, a care home operated by RPFI. The Jury identified concerns about inadequate governance, staffing, training, documentation, leadership and oversight, and found contributory errors or omissions in risk management, including failure to follow advice to take Sophie to A&E, inadequate observation and poor control of access to ligature items.
Read the report on judiciary.uk
× Source evidence
How this individual concern was interpreted PFD Monitor created a concise, searchable interpretation from the report wording shown below.
PFD Monitor interpretation Untrained and unqualified care staff
Wider context from the report “The governance of Lancaster Lodge, and of the staff, and others, working there during the material period, was inadequate in the following respects:
1. There was no “registered manager” who met the statutory criteria.
2. The staff were (despite RPFI’s assertions to the contrary), generally, untrained, unqualified and too few in number.
3. There were no, or no adequate, checks and controls by the staff, or by the acting manager, on the keeping of essential documents, including risk assessments and progress notes, which were, in consequence, themselves inadequate, unreliable and misleading - with corresponding risk to the safety of the residents.
4. The changes to which the determined circumstances refer were made following an audit by ████████ out:
• ████████ was not qualified clinically, or in the field of mental health, to conduct that audit;
• the audit conducted by him (which led to the proposals for change) took only a single day, which was grossly inadequate;
• there was no, or no adequate, consultation with the staff, or by the staff with the residents, regarding the substantial changes introduced, and to be made; and
• the changes were introduced at a “launch”, with no, or no adequate regard to the negative impact of their sudden introduction on the mental stability of the residents.
5. Leadership and oversight by the Board of RPFI was grossly inadequate, in relation to:
• the need to have in place robust employment procedures;
• the matters listed under paragraphs 1 to 4 above;
• the appointments of the clinically unqualified ████████ and, later, the clinically unqualified art therapist as Clinical Lead, of a statutorily-approved registered manager, and of an adequate number of trained and qualified staff;
• supervision and control of the changes introduced at ████████ instigation;
• decisions made by the (unqualified) acting manager and staff in relation to the treatment to be given to the residents, and other steps required to meet their needs, and safety;
• communication with other agencies involved in the care of the residents;
• the keeping and production (including to the Court, for the purpose of the inquest) of the Board’s own records, communications and contracts; and
• knowledge and performance of the Board’s fundamental obligations, including their duty of candour (not least in the Board having failed to fulfil its mandatory obligation to report to the CQC five instances of admission of Lancaster Lodge residents to hospital).
6. Advice to the acting manager was provided by ████████ - the founder of RPFI - and significant decisions regarding Lancaster Lodge and the residents, were made by her (in each case as a “consultant” to the Board, rather than by the Board of RPFI), and were followed by RPFI staff, when:
• ████████ was neither a director, nor a Trustee, of RPFI (one Board member describing her role as “somewhat ambiguous”, and the evidence suggesting that she was a “shadow director”); and
• ████████ had never visited Lancaster Lodge, and had never met (or had any knowledge, firsthand, knowledge of the residents).
7. The possibility of there being:
• a conflict between the interests of ████████ (who, it appears, may have had a personal or family connection with the ownership of Lancaster Lodge) and those of RPFI itself; and
• financial impropriety, in relation to the lease under which Lancaster Lodge was (it seems) held.
8. The post-death investigations carried out on behalf of RPFI:
• were inadequate, verging on self-serving, and not objective; and
• give rise to concerns as to their veracity and accuracy (the authorship of certain supposedly contemporaneous statements being denied by the staff member whose name appears on them as their maker).
9. The facts that:
• a director and trustee of RPFI is also the Chairman of RCI; and
• ████████ appears to have some family connection with the owner of RCI’s premises
give rise to concerns in relation to RCI corresponding to those itemised under paragraphs 5 to 7 above.
” Source location Sophie Bennett · Prevention of Future Deaths report
Open source report
13 Oct 2016 Robert Arthur Davidson · Prevention of Future Deaths report Birmingham and Solihull
View report summary
Concerns raised 1
Lack of objectively assessed basic training and competence standards for HCAs View source
This report raised 3 other concerns. They are not shown here because they do not form part of this recurring concern.
Linked responses
Avery Healthcare Group Care Quality Commission Department of Health and Social Care
Stated actions An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised. 5
Care Quality Commission
Incorporate Care Certificate standards into guidance for providers and assess induction compliance during inspections.
View source
Care Quality Commission
Inspect care homes’ emergency response, staff training, induction, and transfer-risk arrangements, including follow-up checks against the reported concerns.
View source
Department of Health and Social Care
Maintain the Care Certificate as an induction and development standard covering safe, effective care for health and social care workers.
View source
Department of Health and Social Care
Provide £12 million through the Workforce Development Fund to support adult social care employers with workforce training and qualifications.
View source
Department of Health and Social Care
Continue working with Skills for Care to improve adult social care workforce skills.
View source See 2 more actions
×
AI-generated summary
Robert Arthur Davidson · Prevention of Future Deaths report
This summary was generated using AI from the published report. Please read the original report for the complete account.
Report summary
Robert Arthur Davidson, who had dementia, Alzheimer’s disease and PICA, died after choking on a plastic glove at a care home on 27 January 2016. The report identified concerns about inadequate transfer of information about his PICA, insufficient staff training and failures in emergency procedures, including calling emergency services and initiating CPR.
Read the report on judiciary.uk
× Source evidence
How this individual concern was interpreted PFD Monitor created a concise, searchable interpretation from the report wording shown below.
PFD Monitor interpretation Lack of objectively assessed basic training and competence standards for HCAs
Wider context from the report “2. The two HCA’s had no experience or basic training before starting work as HCA’s. They had limited understanding of conditions and processes. Consideration needs to be given as to whether there should be mandatory training or minimum standards, which are objectively assessed, to ensure HCA’s have the necessary knowledge and understanding to undertake their role.
” Source location Robert Arthur Davidson · Prevention of Future Deaths report
Open source report
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Incorporate Care Certificate standards into guidance for providers and assess induction compliance during inspections.
Verbatim wording from the response “CQC refers to the Care Certificate in the ‘Guidance for providers on meeting the regulations. The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014’. The guidance states, “That providers must have an induction programme that prepares staff for their role. It is expected that providers that employ healthcare assistants and social care staff support workers, should follow the Care Certificate standards to make sure new staff are supported, skilled and assessed as competent to carry out their roles”. CQC therefore on inspection looks to see if the provider’s induction incorporates the Care Certificate standards.” Source location 2016-0363-Response-by-Care-Quality-Commission
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Inspect care homes’ emergency response, staff training, induction, and transfer-risk arrangements, including follow-up checks against the reported concerns.
Verbatim wording from the response “During the course of the CQC focused inspection of Aran Court Care Centre on 09 March 2016, we found systems in place to ensure that nurses had training in emergency first aid. Emergency First Aid at work training provides delegates with an extensive first aid skill set so that they can identify incidents and manage them appropriately, whether the patient is conscious or unconscious. The course is designed to include first aid priorities, managing incidents, basic life support (CPR), unconsciousness, control of bleeding, burns and scolds, recording and reporting First Aid Priorities.” Source location 2016-0363-Response-by-Care-Quality-Commission
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Maintain the Care Certificate as an induction and development standard covering safe, effective care for health and social care workers.
Verbatim wording from the response “In April 2015, the Government introduced the Care Certificate (as recommended by Camilla Cavendish in her July 2013 review), which is helping to ensure that support workers and their employers can deliver a consistently high quality standard of safe, effective and compassionate care. It includes 15 standards and outcomes that health and social care workers – in hospitals, care homes and people’s own homes – should know and be able to deliver in their daily work. Regarded as ‘best practice’ for the induction of new health and care assistants, it is also offering existing staff an opportunity to refresh or improve their knowledge.” Source location 2016-0363-Response-by-Department-of-Health
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Provide £12 million through the Workforce Development Fund to support adult social care employers with workforce training and qualifications.
Verbatim wording from the response “The Department is providing significant levels of funding to support training and development for the care workforce. In 2016/17, DH will invest £12m through the Workforce Development Fund which provides support to employers on modules and qualifications for their workers in adult services in the private and voluntary sectors.” Source location 2016-0363-Response-by-Department-of-Health
Open published response
×
Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Continue working with Skills for Care to improve adult social care workforce skills.
Verbatim wording from the response “The Department is also continuing to work closely with our delivery partner, Skills for Care, a partner in the sector skills council for social care, to improve the level of skills of the adult social care workforce.” Source location 2016-0363-Response-by-Department-of-Health
Open published response
×
Source evidence
How this respondent position was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Recruitment, induction and care-certificate arrangements are considered sufficient to ensure HCAs have appropriate qualities, aptitude and role preparation.
Verbatim wording from the response “As a provider Avery Healthcare does have appropriate systems and documentation in situ to address each of the above points.” Source location 2016-0363-Response-by-Avery
Open published response
×
Source evidence
How this respondent position was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Care Certificate induction standards and workplace competence assessment were considered sufficient to ensure HCAs had necessary knowledge and skills.
Verbatim wording from the response “The Care Certificate was developed jointly by Skills for Care, Health Education England and Skills for Health, and introduced on 01 April 2015. These Care Certificate standards apply across both social care and health, and link to the national occupational standards. The Care Certificate is designed for new HCA staff, it also offers opportunities for existing staff to refresh or improve their knowledge. The new standards encapsulated in the Care Certificate should ensure that the health and social care workers have the required values, behaviours, competences and skills to provide high quality, compassionate care.” Source location 2016-0363-Response-by-Care-Quality-Commission
Open published response
Actions and positions describe what organisations say in published responses. Implementation is not independently verified.