PFD report

Thomas Farrell · Prevention of Future Deaths report

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Issued 14 Jul 2015•Nottinghamshire

Report record

Published report and response evidence

This page connects the concerns raised in this report with statements found in recipients’ published responses. A link shows a clear evidence connection; it does not assign responsibility.

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Concerns
2

Raised in this report

Recipients
1

Named on the report

Responses found
0

Of 1 recipient

Stated actions
0

Described in responses

Recipients and published responses

Source document

Full report text

This is the full text from the original published report.

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Concerns and recipient responses

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Report evidence summary

Concerns raised2

  1. Failure to obtain a full record of residents’ prescribed drugs
    Part of recurring concern: Unreliable access to relevant clinical records for safe care
  2. Failure to administer indicated prescription drugs
    Part of recurring concern: Unsafe medication administration
Responses linked to these concerns

Each statement is shown once, even when linked to more than one concern.

No linked response statements

No respondent-stated action or position is clearly linked to these concerns.

Source evidence

How this individual concern was interpreted

PFD Monitor created a concise, searchable interpretation from the report wording shown below. Response links show a clear evidence connection; they do not assign responsibility.

PFD Monitor interpretation

Failure to obtain a full record of residents’ prescribed drugs

Wider context from the report

“1. That the Home did not know the true extent of the prescription drugs which were indicated for Mr Farrell while he was a resident, having not approached Mr Farrell’s GP for a full record. The result of this was that the prescription drugs aspirin, senna, doxalil and omeprazole were not given. Whilst in the event this did not cause or contribute to his death on 16th July 2014, the risk of such an omission causing death in other circumstances is clear. ”

Is this part of a recurring concern?

Yes — Unreliable access to relevant clinical records for safe care.

Open source report

Source evidence

How this individual concern was interpreted

PFD Monitor created a concise, searchable interpretation from the report wording shown below. Response links show a clear evidence connection; they do not assign responsibility.

PFD Monitor interpretation

Failure to administer indicated prescription drugs

Wider context from the report

“1. That the Home did not know the true extent of the prescription drugs which were indicated for Mr Farrell while he was a resident, having not approached Mr Farrell’s GP for a full record. The result of this was that the prescription drugs aspirin, senna, doxalil and omeprazole were not given. Whilst in the event this did not cause or contribute to his death on 16th July 2014, the risk of such an omission causing death in other circumstances is clear. ”

Is this part of a recurring concern?

Yes — Unsafe medication administration.

Open source report
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Information checked against the published report and official responses · Data reviewed 7 Sep 2026 · About data quality and limitations

Official responses located
0/1

Data last updated 7 September 2026

No official response is included in the current published snapshot.