PFD report

Eldine Loretta Lashley · Prevention of Future Deaths report

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Issued 16 Sep 2021•East London

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

Select any concern, action or position to view the source wording.

Concerns raised2

  1. Failure to accurately record the frequency of checks in progress notes
    Part of recurring concern: Incomplete, inaccurate or unavailable clinical and care recordsPart of recurring concern: Unreliable recording of required observations in care and custody
  2. Failure to update mobility care plans in response to changing care needs
    Part of recurring concern: Unreliable care-planning processes
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 accurately record the frequency of checks in progress notes

Wider context from the report

“1. Mrs Lashley's mobility care plan was not updated in response to developments in her care needs – specifically she need to observe her more frequently than once per hour. 2. Progress notes created by nursing and care staff did not accurately reflect the frequency of checks carried out on Mrs Lashley. ”

Is this part of a recurring concern?

Yes — Incomplete, inaccurate or unavailable clinical and care records; Unreliable recording of required observations in care and custody.

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 update mobility care plans in response to changing care needs

Wider context from the report

“1. Mrs Lashley's mobility care plan was not updated in response to developments in her care needs – specifically she need to observe her more frequently than once per hour. 2. Progress notes created by nursing and care staff did not accurately reflect the frequency of checks carried out on Mrs Lashley. ”

Is this part of a recurring concern?

Yes — Unreliable care-planning processes.

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

Data last updated 7 September 2026