PFD report

Jill BRICE · Prevention of Future Deaths report

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Issued 20 Oct 2023•West Sussex, Brighton and Hove

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
1

Raised in this report

Recipients
2

Named on the report

Responses found
1

Of 2 recipients

Stated actions
1

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 raised1

  1. Failure to ensure care residents keep their pendant close to them at all times
Responses linked to these concerns

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

Respondent positions A position is what a recipient says about a concern when it does not describe a specific action.2

  1. Position

    The accommodation provider is not regulated by the respondent, so it cannot provide reassurance about reminding residents to keep pendants nearby.

    Stated by Care Quality CommissionOutside remitThe respondent said that this matter was outside its role or authority.

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 ensure care residents keep their pendant close to them at all times

Wider context from the report

“The Fire Safety Report recommended that care residents be reminded to have their pendant close to them at all times. I would like reassurance that this be actioned. ”

Is this part of a recurring concern?

No recurring-concern membership is currently published.

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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 accommodation provider is not regulated by the respondent, so it cannot provide reassurance about reminding residents to keep pendants nearby.

Verbatim wording from the response

“Unfortunately, we are unable to provide reassurance required regarding this concern or to comment upon it. The accommodation where Jill Brice resided was sheltered accommodation managed by the Teachers Housing Association, a not-for-profit charitable organisation. This organisation is not registered with us and therefore not regulated by us. The Teachers Association would not be required to register with us unless it was providing a regulated activity, as defined in section 8 of the Health and Social Care Act 2008 and Part 1 paragraph 2 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014.”

Source location

Response from Care Quality Comission
Page 1 · response
Published 1 November 2023

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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

Provisionally, the location falls outside registration requirements and therefore outside the scope of regulation.

Verbatim wording from the response

“We have undertaken a rapid review of the concerns raised in your Regulation 28 report and established that the location where Mrs Brice was residing at the time of her death, namely the Dene, the Green, Rottingdean, Brighton, was not registered with us.”

Source location

Response from Care Quality Commission
Page 1 · response
Published 1 November 2023

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Other statements in published responses

These actions and other statements could not be clearly connected to one concern in this report.

Recipient-stated actions An action is something a recipient says it has done, is doing, or plans to do in response to a concern raised.1

  1. 1

    Improve processing procedures to prevent recurrence of Regulation 28 response delays.

    Stated by Care Quality CommissionStated plannedThe respondent said that this action was planned when they made their response on 1 November 2023.

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

Improve processing procedures to prevent recurrence of Regulation 28 response delays.

Verbatim wording from the response

“Due to a processing error, your Regulation 28 report was not considered for review until 2 January 2024. We take Regulation 28 reports very seriously and value the information contained within them for the purposes of helping inform proper discharge of our regulatory functions. We therefore very much regret the delay that this error has caused. We will seek to address that error at pace with process improvements to ensure that there is no repetition of the issue.”

Source location

Response from Care Quality Commission
Page 1 · response
Published 1 November 2023

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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