Alison Evers

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Civic Hall
Leeds LS11UR

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Our Ref: A72/NM/
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27 April 2015

Dear Ms Alam,

Re Inquest touching the death of Alison Dawn Evers (deceased)

Thank you for your letter dat ua nclosing a Regulation 28 Report to Prevent
Future Deaths addressed to ee of Adult Social Care of Leeds City
Council. This was issued to the ouncil as a result of the Inquest touching the tragic death of
Alison Evers.

The Report details three matters of concern as follows:

(i) The lack of a written “no treats” policy;

(i) The lack of a policy ensuring a first aid trained member of staff is on duty for
each shift;

(iii) The level of first aid training of health support workers, particularly if working
with service users who suffer from cognitive and/or physical impairment and are
dependent on carers to meet their personal and dietary needs.

| will address each recommendation in turn but believe that before doing so it is necessary to
set out the scope of the services that the Learning Disability Community Support Service
provides; the highly divergent customer group that it serves; and the vast number of bases

The Learning Disability Community Support Service

This Service exists for the Purpose of serving the social care needs of people with learning
disabilities and their carers. The defining purpose of this individualised and person centred
service is to promote the best interests of each of its customers. It does this by:

1. enhancing the quality of their lives and experiences;

www.leeds.gov.uk general enquiries 0113 222 4444 Law Socity Accreaited

2. by maximising their independence and reducing the need for institutional care;
3. by helping them to have a positive experience of care and support; and
4. by safeguarding and protecting them from avoidable harm.

This Service provides support to over 800 customers who present a very wide range of
different needs and requirements. This Service does not provide health care per se; its focus
is to provide social care to customers with learning disabilities. The individual needs of each
prospective customer are assessed prior to being accepted by this Service, and on an on-
going basis if appropriate. if the medical needs of a customer are or become complex or
severe then that person’s needs are met by other more appropriate Services.

The needs of the Learning Disability Community Support Service customers are met by three
distinct and different sub-services as follows:

The Supported Living Service

This Service provides support for over 300 people who are able to live their lives in their own
homes or in small group settings with varying degrees of independence. The focus of the
Service is to support and promote the customers’ autonomy and independent living. This
service is provided at over 90 separate properties within the community and the level of
support may range from just a couple of hours each week right up to full time support 24
hours a day for 7 days a week.

The autonomy of the individuals using this service and their right of self-determination and
freedom of choice is promoted, protected and respected. Customers are frequently supported
with daily living activities, such as using public transport, visiting shopping centres and
supermarkets, visiting cafes, accessing community groups and public places, participating in
exercise, drama and workshop groups compatible with their individual interests and skills.

Most of the customers that this Service supports do not have any significant health needs.
They typically include individuals affected by conditions such as Autism or Downs Syndrome
and whilst they do need social Support they are no they more likely to need first aid than any
other member of the public. The care staff that this Service retains are ail First Aid trained,
and | believe that the arrangements that are currently in place (details of which are provided

below) are appropriate.

In relation to a “no treats” policy the customers using this service usually have clear wishes
about the items that they purchase (with varying levels of assistance of staff members) whilst
out in the community, such as a cake or confectionary “treat” at a café or from a shop. It
would be inappropriate, undesirable and detrimental for staff to be unable to support this

appropriate expression of their wishes.

Respite Care and Crisis Service

This service offers an Opportunity for more than 200 customers each year to have short stays
away from their families. It also gives family carers a break from their caring responsibilities.

The Crisis Service provides services to customers whose circumstances have changed or
who have been affected by an emergency and provides them with care whilst more
permanent arrangements are made.

The range of customers and their needs from us as Service providers varies tremendously.
Many, if not most, of these customers do not have complex heaith needs. By definition, our
respite customers are cared for in ordinary domestic family settings where first aid experience
or the refusal of treats does not form any part. The purpose of the respite service is to offer to
our customers an enjoyable change from their normal routines; it is also designed to offer
families peace of mind that their loved one is being well cared for, and having an enjoyable
“holiday away “while they too benefit from a break from their caring responsibilities. In these
circumstances to introduce and impose a “no treats” policy would present a negative
experience for our customers and would amount to an inappropriate and potentially
oppressive fetter on their free expression of wishes and desires. It would be inimical to the
purpose of the service and would undermine its function,

Therefore, again, for these reasons, the introduction of a written mandatory “no treats policy”
would not appear to be an appropriate or a desirable development, nor does there appear to
be a need for additional first aid training for staff over and above that which they are already

given as a maiter of course (see below).

Fulfilling Lives Service

This Service provides support to over 800 customers some of whom have more significant
learning disabilities and who need a high level of support.

The focus of the service provided to these customers is to provide socially enjoyable, healthy,
safe, fulfilling and enriching activities during the daytime. Services are provided at the
Council’s own buildings and facilities and through partnership working with over 20 Third
Sector service provider organisations.

Currently services are provided to customers from 23 specialist buildings and bases co-
located in sports and community centres across Leeds. The aim of the Service is to maximise
opportunities for social inclusion and to promote community access and participation,

This service has recently undergone a modernisation programme to enable it to move from
an oid “one size fits all approach” where services were provided at designated centres which
were isolated from their wider communities and which were only accessed by customers and
their families. The Councii now provides far more flexible personalised services with new
community bases being opened across Leeds within existing facilities, such as Leisure
Centres, which provide services to all sectors of the community. In addition existing buildings
are being refurbished and a new centre is being built. in line with this modernisation
Programme, customers generally participate in smaller group activities over a wide and
diverse range of bases across the City.

Just over half of the customers who access this Service live at home with family carers.
Therefore, as in the case of our respite customers, by definition, the needs of these
customers do not necessitate a high level of first aid/medicalised training. Nor do the normal

lives of our customers include “no treat” rules.

In relation to the Areas of Concern specifically raised by the Coroner, the Council’s position is
set out below.

The lack of a written “No Treats Policy”

The ethos of the Council's Social Care Services is to provide in all cases the best and most
appropriate person centred care that it can for each individual that it serves. The customers of
the Learning Disability Community Support Service have vastly divergent and highly
individualised needs and wishes. We aim to meet them all. To achieve this we have created a
range of highly personalised risk assessment tools and Individual Support Plans which are

bespoke to each of our customers.

Prior to entry into our Service, each customer's individual needs are assessed in detail with
the support and assistance of appropriate professionals such as (in the case of feeding and
choking risks) Dieticians and Speech and Language Therapists who advise upon the types of
suitable foods and in the optimal manner of preparation and presentation to our customers.
These assessments cover all aspects of our customers’ individual needs, and lead to the
preparation of their Individual Risk Assessments, and Individual Support Plans.

We organise staff teams so that our staff work with smail groups of customers on a consistent
basis and are very familiar with their individual needs, and are knowledgeable in how to
appropriately meet and respond to them.

in the case of feeding, each customer who has a need for a modified diet has a “placemat”
plan prepared for them. This placemat goes with the customer on all outings and is therefore
visible and in use at all times when the consumption of food or drink is being planned and is

taking place.

The Council notes the matter of concern that has been raised in relation to a lack of a written
ireats policy, However, in the case of a customer who has been assessed as being at risk of
choking due to an impaired ability to ingest a normal diet, the risk of choking is presented not
just by “treats”, but by all foods which are presented to that person in an unsuitable form. The
Council therefore believes that the current practice that it has in place, which addresses all
foods that an individual is to be offered is a more appropriate measure to protect its
customers from a choking risk.

The Council fully accepts and deeply regrets that Alison’s death was contributed to by neglect
on the part of a member of its care staff who failed to comply with the Individual Support Plan
and Risk Assessment that had been prepared for, and which was tailored to, Alison’s needs.
Alison’s Individual Support Plan was created by care staff working in conjunction with
appropriate specialist professionals. It contained specific advice that Alison was at risk of
choking and that the action necessary to manage that risk was to ensure that her food was
liquidized/finely chopped before it was served to her.

All risk assessments are kept under regular review. In the case of Alison, all staff working with
her were very familiar with it. The practice of the Learning Disability Community Support
Service is that all new staff (whether they be agency or permanent staff) receive a full
induction and training before working directly with customers. Having first read the care plans,
all new staff are gradually introduced to the customers with whom they will be working whilst
working alongside and shadowing established workers. In this way they gain customer
Specific knowledge of each customer's individual care plans, risk assessments and needs
and gain insight and experience of best practice. Only after this process has taken place are
new staff permitted to work directly with customers.

Had Alison’s well documented care plan been adhered to (as it always had been previously),
this dreadful event would not have occurred.

First Aid Training

As previously mentioned, the customers that are served by the Learning Disability Community
Support Service do not generally present with complex and additional medical needs. There
is therefore no need for the service to engage the services of “health support workers” as

mentioned in the Coroner's report.

The Council provides staff with First Aid Training as part of its on-going programme of
continuing professional development. The courses which are provided are First Aid in Work

and Fundamental First Aid.

All new staff working within the Learning Disability Community Support Service receive
training on Fundamental First Aid as part of their induction programme. The course content
for the Fundamental First Aid (or Emergency First Aid) course is as follows:

Objectives by the end of the course — you will be able to:
¢ Act safely, promptly and effectively in an emergency;
Treat an unconscious casualty (including seizure)
Prevent cross infection
Perform effective Adult CPR
Understand the differences between Adult, Child and Bab y CPR
Recognise and treat the following:
o Choking; Bleeding; Shock

ee ees

The First Aid training regime is a rolling programme. Both the First Aid at Work and the
Fundamental First Aid training qualifications last for 3 years after which they should be

547 staff have successfully compieted the Fundamental First Aid/Emergency First Aid course.

| therefore believe that the Council's current training regime meets the concern that the
Assistant Coroner expressed in her report.

Finally, on behalf of the Council and the staff who worked with and cared for Alison, | wish to
again express sincere and heartfelt condolences to Alison’s family and loved ones for her

tragic loss.

Yours faith
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Civil Litigation