Recipient

Coxbench Hall

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First report 7 Dec 2017•Latest report 7 Dec 2017

Recipient record

Reports, concerns and published responses

Private and voluntary organisations · Residential care home. This page brings together reports naming this recipient and response statements clearly connected to concerns raised in those reports.

Reports
1

Naming this recipient

Published responses
0%

Found for named reports

Concerns addressed
0

Across all linked responses

Stated actions
0

Described in responses

Reports over time

Reports over time

Reports naming this recipient by issue year.

Evidence profile

Report topics

Share of this recipient’s reports compared with all other recipients.

0%published responses found
0stated actions described

Topic comparisons are not available in the current evidence snapshot.

Concerns and recipient responses

Statements from Coxbench Hall linked to the concerns in each report. Select any concern, action or position to view the source wording.

  1. Derby and Derbyshire

    AI-generated summary

    Kenneth Cottam · 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

    Kenneth Cottam, an 89-year-old resident of Coxbench Hall Residential Home, sustained a subdural bleed after one of two reported falls and died in hospital on 13 April 2016. The court heard that no falls risk assessment was carried out and that staff did not consider a possible link between his confusion and an earlier fall, while concerns were raised about the clarity, robustness and consistent implementation of falls prevention and management procedures.

    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. The report was sent to Coxbench Hall; that does not assign responsibility.

    PFD Monitor interpretation

    Lack of clear and robust policies and procedures for falls risk assessment and management

    Wider context from the report

    “Having heard evidence from the management team at Coxbench Hall Care Home, the court was not reassured that there are clear and robust policies and procedures in place in relation to falls prevention and falls management, or that those policies and procedures are widely and consistently understood by staff. (1) The court was not reassured that there are clear and robust policies and procedures in place in relation to falls risk assessment and management. (2) The court was not reassured that staff had a sufficient understanding of the falls policies and procedures in place to enable them implement them consistently and appropriately. ”
    Open source report

    Source evidence

    How this individual concern was interpreted

    PFD Monitor created a concise, searchable interpretation from the report wording shown below. The report was sent to Coxbench Hall; that does not assign responsibility.

    PFD Monitor interpretation

    Failure of staff to sufficiently understand falls policies and procedures for consistent and appropriate implementation

    Wider context from the report

    “Having heard evidence from the management team at Coxbench Hall Care Home, the court was not reassured that there are clear and robust policies and procedures in place in relation to falls prevention and falls management, or that those policies and procedures are widely and consistently understood by staff. (1) The court was not reassured that there are clear and robust policies and procedures in place in relation to falls risk assessment and management. (2) The court was not reassured that staff had a sufficient understanding of the falls policies and procedures in place to enable them implement them consistently and appropriately. ”
    Open source report
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Published response patterns

Compared with other recipients in reports included in PFD Monitor

Describes published response evidence, not performance.

Published responses found

0%
0%All other recipients 58%
0%100%

How actions were described at the time

This respondent
All other recipients
47%25%27%<1%<1%
  • Completed
  • In progress
  • Planned
  • Unclear
  • Partially completed

Statuses reflect what recipients said at the time. PFD Monitor does not verify whether actions happened.

Types of action described in responses

Percentages use all actions described by each group. An action may have more than one type, so percentages do not total 100%.

Information checked against published PFD reports and official responses · Data reviewed 7 Sep 2026 · About data quality and limitations

Data last updated 7 September 2026