Daphne Cherry

care E3 

Care UK Community Partnerships 
Limited 
Connaught House 
850 The Crescent 
Colchester Business Park 
Colchester 
Essex
C049QB

www careuk.com 

Ms Katy Skerrett 
HM Senior Coroner for Gloucestershire 
Gloucestershire Coroner's Court 
Coronium Avenue 
Barnwood 
Gloucester GL4 3DJ 

05 May 2017 

Dear Ms Skerrett, 

Daphne Cherry deceased - Prevention of Future Deaths report 

We  write  further to  your letter of 15 March,  2017,  and  in  particular the  Prevention  of Future 
Deaths report issued following  Mrs Cherry's Inquest.  As you  know, Care UK had  already put 
in  place  a  number of changes  following  Mrs  Cherry's  death  but welcomes  the  opportunity to 
consider further improvements. 

We note that you  are concerned  whether  staff at  Sandfields Care  Home  are  able to  identify 
when  a  medical  concern  should  be  escalated  and  a  review  sought.  The  actions  we  have 
taken are as follows. 

As a preliminary point, Sandfields employs a number of registered  nurses and there is always 
at  least  one  on  duty  at  any  given  time.  As  the  Coroner  will  be  aware,  nurses  undergo 
extensive  professional  training  which  would  cover  recognition  of  the  clinical  symptoms 
exhibited  by  a deteriorating  resident.  Care  UK  has  nonetheless taken  further  action  both  to 
supplement  this  professional  knowledge  of  our  nurses,  and  also  to  train  the  rest  of  the 
Sandfields  staff  (including  those  who  are  non-clinically  trained)  in  recognising  deteriorating 
residents. 

The home  manager, deputy home  manager and  the  home's  unit leaders  have all  undergone 
training  in  'Early recognition of the sick and deteriorating patient', which has been provided by 
the  Care  Home  Support  team  based  at  Gloucestershire  Care  Services  NHS  Trust. 
In 
essence, they are an  NHS service funded  jointly by Health and  Social Care, and they provide 
education  and  training  to  care  homes  across  Gloucestershire.  They work  closely  with  key 
stakeholders in  the sector, including the  CQC  and  CHC.  We enclose a  link to their website, 
should the Coroner need any further information: 

https://www.glos-care.nhs.uk/our-services/specialist-care/care-home-support 

We are  awaiting further dates for training  sessions to be  released  by the Care Home Support 
team, and as soon as they have been made available then all shift leaders will be booked onto 
upcoming sessions.  We expect the dates to be released in the next couple of weeks. 

Alongside  this,  and  in  order to augment the training, the  unit  leaders  have  been  specifically 
tasked , in conjunction with the Care UK governance team, with cascading the principles of the 

Cate UK Commun,ty Pannenhops LJm,ted - Registered In England No 2644862 
Registered Office  Connaught House. 850 Th& Crescent COlc:nester Business P811<.  Colchester, Essex C04 90B 

 
 training  to the  shift leaders.  This is  to ensure that  staff are  brought up to speed  as soon  as 
possible,  and  not  simply  waiting  for  the  further  Care  Home  Support  training  dates.  Unit 
leaders will  meet with shift leaders on  a one-to-one basis to take them through the  principles. 
These meetings are to have taken place by 15 May, 2017.  Once this phase is complete, one 
of the  unit leaders will  also  be  responsible  for training  the  remaining  care  home  staff.  This 
process  will  be  completed  by the  end  of June 2017  and  will  capture fill staff working  in  the 
home.  The  principles  will  also  be  reinforced  on  an  ongoing  basis  as  part of individual  staff 
supervision. 

The net result of the  above  actions is that all  staff within the home will  have  received  training 
in  recognition  of deteriorating  residents  by  the  end  of June  2017.  We  have  not  limited this 
process  to clinical  staff,  as  we  consider it is  important that fill_staff  are  able  to  recognise  an 
unwell resident and understand what to do. 

In  terms  of the training  itself, it includes an  escalation  numbering  system  to alert staff to  the 
seriousness  of  the  resident's  condition,  otherwise  known  as  the  'National  Early  Warning 
Score',  (or  'NEWS').  This  provides  an  algorithm  by  which  six  physical  parameters  are 
measured and given a score.  The overall score then  provides  staff with a clear indication as 
to what type of response  is required  to  each  clinical scenario, so whether this is  a call  to the 
111  service, a GP or an ambulance. 

The training also incorporates understanding "SBAR" - i.e. Situation, Background, Assessment 
and  Recommendation.  This  is  an  action  list  used  as  an  aide  memoire  for  staff  relating 
information to 111/GP services.  Sandfields keeps a copy of the  list next to the telephones so 
that it prompts staff when they are speaking to other medical teams. 

It encompasses: 

S - Situation (a concise statement of the problem) 

B - Background (pertinent and brief information related to the situation) 

A - Assessment (analysis and considerations of options - what you found/think) 

R - Recommendation (action requested/recommended - what you want) 

We  recognise  that  it  is  important  to  also  monitor  the  efficacy  of training  and  knowledge-
building,  and this is the  responsibility of the  home manager and  deputy home manager.  One 
of them will be on duty at any one time, including evenings and weekends.  There is therefore 
24/7 management coverage.  As we mentioned above, there is also always a nurse on duty. 

In  order to check that staff are responding  appropriately to resident's  clinical needs, it is their 
responsibility to discuss unwell residents with the manager or the deputy during daily meetings 
and walkarounds.  This includes an  outline of the clinical presentation, and  the actions taken 
by that member of staff in  response.  If it is  during the weekday core hours, then  staff should 
approach the manager to discuss a  resident.  If it is during the  evening or early hours of the 
morning then they should escalate to the nurse in  charge who, in turn, is expected to contact 
the on-call manager if unsure about what to do.  At weekends, the on-call manager telephones 
the home to discuss unwell residents in order to ensure appropriate actions have been taken. 

This  process  provides  effective  scrutiny  of the  staff's  decision-making,  and  reinforces  any 
learning points.  It is effectively an ongoing audit process, to ensure safe care to residents.  It 
is not an additional step in the process which  might cause delay as staff have to check with  us 
before taking action.  It is about oversight of the decisions that have been made by staff, and if 
there  is  an  emergency  then  they  are  expected  to  contact  the  appropriate  services  without 
delay. 

Page 2 of 3 

 In addition to the Coroner, we have also been liaising with the CQC in relation to the changes 
which  have been made within Sandfields.  In particular, we outlined those changes described 
above  and  we  received  correspondence  in  response  from  our  local  CQC  inspector,  Vicky 
Dale, on 4  May 2017, stating that: 

"/ have made a note of your comments and can see that action has been taken to ensure staff 
are  skilled  and  competent  to  recognise  and  escalate  concerns  when  a  person's  health 
deteriorates  and  that  processes  have  been  implemented  to  support  the  staff training  and 
expected standards of care. " 

We are therefore confident that we have implemented a robust series of improvements, which 
will  result  in  staff  understanding  and  responding  to  the  clinical  needs  of  an  unwell  and 
deteriorating resident. 

Yours sincerely, 

Sandfields home manager 

Page 3 of 3