Recipient

Westfield Residential Home

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First report 26 Jun 2026•Latest report 26 Jun 2026

Recipient record

Reports, concerns and published responses

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
100%

Found for named reports

Concerns addressed
3

Across all linked responses

Stated actions
11

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.

100%published responses found
11stated actions described

Topic comparisons are not available in the current evidence snapshot.

Concerns and recipient responses

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

  1. East Riding and Hull

    AI-generated summary

    Susan Dale · 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

    Susan Dale, a resident of Westfields Residential Home, fell while being assisted with her morning routine on 8 April 2026 and later deteriorated, was taken to hospital, and died on 18 April 2026. The principal concerns were inaccurate and inconsistent records about the fall, moving her despite a recorded possible head injury without prompt clinical assessment, and the absence of an effective handover to staff taking over her 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. The report was sent to Westfield Residential Home; that does not assign responsibility.

    PFD Monitor interpretation

    Inaccurate and inconsistent record keeping

    Wider context from the report

    “(1) The record keeping in the home appears to be inaccurate and inconsistent ”
    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 Westfield Residential Home; that does not assign responsibility.

    PFD Monitor interpretation

    Failure to provide handover information between care shifts

    Wider context from the report

    “(3) The senior care worker who came on shift later that day said she did not receive any hand over from the staff going off shift. This is a concern as observations need to be carried out when someone has fallen and banged their head and a handover would detail such incidents and whether there are any concerns with residents. ”
    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 Westfield Residential Home; that does not assign responsibility.

    PFD Monitor interpretation

    Failure to follow the falls policy for suspected head, neck, back or hip injury

    Wider context from the report

    “(2) The falls policy of the home states that there are number of scenarios to consider before lifting a resident for the floor and states that the resident should not be moved until clinical assistance arrive. One such situation is if head, neck, back or hip injury is suspected. The incident log on advanced care cloud states there was ahead injury yet Mrs Dale was moved and no clinician saw her until she worsened and ambulance was called. Inaccuracies in reporting can lead to missed opportunities to provide care and inaccurate time recording of incidents can lead to the accurate appraisal of the developing clinic picture being made more difficult which in turn would lead to a delay in medical assistance being sought. This could lead to resident safety being compromised and deaths occurring. ”
    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

    Implement the electronic care management system and complete staff training for its use.

    Verbatim wording from the response

    “As part of the Home’s ongoing commitment to continuous quality improvement, a new electronic care management system has recently been introduced to replace the previous record-keeping platform. Staff training is currently being delivered as part of the phased implementation to ensure all staff are confident and competent in using the new system.”

    Source location

    Response from Westfield Residential Home
    Page 1 · response
    Published 2 September 2026

    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

    Operate the Resident of the Day process to review care plans, risks, mobility, falls risk and documentation.

    Verbatim wording from the response

    “Policies of the month at Westfield are now already in circulation in which an emphasized and updated Falls policy will also be given to any existing and any new staff. A system of Resident of the Day has also already commenced which demonstrates:”

    Source location

    Response from Westfield Residential Home
    Page 2 · response
    Published 2 September 2026

    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

    Hold the scheduled staff meeting and practical workshop on falls assessment, observation, escalation and documentation.

    Verbatim wording from the response

    “A dedicated staff meeting and practical learning workshop has been scheduled for 9 July 2026, during which staff will revisit the home’s procedures for assessment, observation, escalation and documentation. The session will further reinforce the circumstances in which advice should be sought from NHS 111 or emergency services, ensuring staff remain confident in recognising when urgent clinical assessment may be appropriate.”

    Source location

    Response from Westfield Residential Home
    Page 1 · response
    Published 2 September 2026

    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

    Operate the structured incident-reporting workflow, including witnessed entries, senior authorisation and management escalation.

    Verbatim wording from the response

    “The platform incorporates integrated accident and incident reporting, body maps and observation charts, providing a streamlined and consistent approach to recording and reviewing incidents. This system ensures time stamped and consistent logs are made which are then reviewed by management for further action before they can be signed off. Furthermore, all seniors have been instructed to use the ‘witness’ portions of these forms to ensure two members of staff are logging one accident at the same time to ensure consistency.”

    Source location

    Response from Westfield Residential Home
    Page 1 · response
    Published 2 September 2026

    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

    Replace the paper diary with a structured handover process providing staff with shared resident information.

    Verbatim wording from the response

    “A new structured handover process is now replacing the old paperback diary format at Westfield ensuring all members of staff can access the same information readily, to ensure all staff are well educated on each residents health.”

    Source location

    Response from Westfield Residential Home
    Page 2 · response
    Published 2 September 2026

    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 monthly governance audits of accident and incident records to monitor documentation and identify service improvements.

    Verbatim wording from the response

    “In addition, monthly governance audits of all accident and incident records have been incorporated within the new system. These audits provide ongoing oversight of documentation, support continuous monitoring of practice and assist in identifying further opportunities for staff development and service improvement.”

    Source location

    Response from Westfield Residential Home
    Page 1 · response
    Published 2 September 2026

    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

    Circulate the updated Falls policy to existing and new staff through the policies-of-the-month programme.

    Verbatim wording from the response

    “Policies of the month at Westfield are now already in circulation in which an emphasized and updated Falls policy will also be given to any existing and any new staff. A system of Resident of the Day has also already commenced which demonstrates:”

    Source location

    Response from Westfield Residential Home
    Page 2 · response
    Published 2 September 2026

    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 all staff with guidance notes on post-fall assessment, safe movement, emergency escalation, monitoring, documentation and reporting.

    Verbatim wording from the response

    “As part of this programme, all staff will receive comprehensive guidance notes covering:”

    Source location

    Response from Westfield Residential Home
    Page 2 · response
    Published 2 September 2026

    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

    Deliver additional training on assessing, managing, escalating and documenting witnessed and unwitnessed falls and injuries.

    Verbatim wording from the response

    “The Home recognises the importance of continually strengthening staff knowledge and maintaining a consistent approach to the assessment and management of incidents.”

    Source location

    Response from Westfield Residential Home
    Page 1 · response
    Published 2 September 2026

    Open published response
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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

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

How actions were described at the time

This respondent
45%36%18%
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