Anthony Wilkinson

HSCA Further Information
Citygate

Gallowgate

Newcastle upon Tyne
NE1 4PA

The Medico-Legal Centre
Watery Street

Sheffield

South Yorkshire

$3 7ES

1 June 2021

Care Quality Commissi

Dear HM Assistant Coroner Abigail Combes

Prevention of future death report following inquest into the death of Anthony
Wilkinson

Thank you for sending CQC a copy of the prevention of future death report issued
following the death of Anthony Wilkinson. CQC has contacted the provider Stars
Social Support Limited (“Stars Social Support’) to request written confirmation and
evidence of the action they have taken to date following this death and any
additional action they intend to take in response to the prevention of future death
report.

CQC has reviewed all the concerns contained in the Regulation 28 report, as well
as the subsequent suggested actions contained in Section 6. We will respond to
each point addressed to CQC in order, as set out in the Regulation 28 report.

Section 5, Point 13 - CQC did not take steps to access records held by the
Police or the provider in a timely fashion following Tony’s death. This
potentially created risk to other service users as the Regulator had not
inspected the service promptly following a significant event.

CQC has reviewed a chronology of steps taken by the local inspection team to
access records held by the Police or the provider to consider the timeliness of the
actions taken. The team requested Anthony Wilkinson’s care records from the
provider less than a week after being notified of his death on 5 April 2018. At this
time the police were carrying out a criminal investigation following the incident and
held primacy of the investigation. In line with The Work Related Deaths Protocol
CQC made contact with the Police on 3 May 2018. The Police had seized original
records from Stars Social Support as part of their investigation. CQC progressed

1

their parallel investigation as much as they reasonably could, however access to
records was limited in the beginning of our initial enquiries due to the police seizing
these, however CQC were in regular contact with the Police to ensure we adopted
a cooperative and coordinated approach. CQC received copies of all records held
by the Police on 29 November 2018 at the conclusion of their investigation.

CQC has reviewed whether, as a result of Anthony Wilkinson’s death, Stars Social
Support should have been inspected sooner than the comprehensive inspection
which was completed on 29 and 30 May 2018. This inspection did not lead to a
rating or a report being published as at that time, the Police had seized Stars Social
Support’s computer servers as part of their investigation, which in turn, impacted
on the availability of key records necessary to make a fair and complete
assessment about the service against all of CQC’s key line of enquiries (KLOE’s).
We have concluded from our review that the inspection of 29 and 30 May was
completed promptly, based on the information and risks we were aware of at that
time. The local inspection team followed internal guidance responding to specific
incidents, assessed the level of risk of harm this incident posed to others at the
service, in conjunction with known CQC intelligence, the service’s regulatory
history, as well as taking into account any relevant stakeholder feedback or actions
to mitigate potential wider risk at the service. CQC were aware Barnsley Local
Authority's safeguarding team had visited Stars Social Support in April 2018 shortly
after Anthony Wilkinson's death and implemented a voluntary embargo on
admissions. Following receipt of the specific incident the local inspection team
assessed the level of risk at the service did not necessitate urgent regulatory action
or an inspection. CQC’s inspection findings on 29 and 30 May 2018, and again on
12 and 13 February 2019, confirmed that our assessment of risk was accurate as
at that time no serious/urgent concerns were identified. Although the inspection on
29 and 30 May 2018 did not lead to a rating or report, the information gathered
from our visit to Stars Social Support’s office and a selection of service user's
homes, assured CQC that people were receiving a safe service at that time.
Therefore, the overall risk level of the service could be de-escalated.

Section 5, Point 14 —- CQC too readily accepted the lack of an action plan
from the provider and did not use this lack of engagement from the provider
to increase the risk profile for this provider. Had they done so an earlier re-
inspection may have been triggered for further regulatory action. This failure
may have exposed other service users to unnecessary risk of harm as a
result of inaccurate picture being provided by the CQC.

We understand point 14 refers to the re-inspection of Stars Social Support
following the February 2019 inspection, where the local team identified two
breaches of regulations. Civil enforcement action was taken; a Warning Notice was
served against the breach of regulation 17; and a Requirement Notice was
serviced against the breach of regulation 19. As a Warning Notice was served, we
did not request an action plan in line with CQC Enforcement Policy. We did,
however, request an action plan be submitted to CQC by 29 May 2019 for the

breach of regulation 19. This breach concerned a failure to complete all staff
recruitment checks in line with regulatory requirements and was assessed as
posing no serious risk to people who used the service.

CQC acknowledged at the Prevention of Future Deaths hearing that the re-
inspection of Stars Social Support (completed on 27 August 2020 to 3 September
2020) fell outside of our usual timeframe of re-inspecting a service, rated requires
improvement, 12 months from the last inspection publication date. However at that
time, the decision not to inspect the service sooner we feel was justified and
proportionate. COVID-19 resulted in CQC adapting its inspection priorities during
the pandemic to ensure risk and people’s safety were the highest priority. A
decision was taken by the CQC that during the pandemic, CQC would take on a
more supportive role, as well as not adding to the overall risk and pressures
COVID-19 presented to the rest of the health and social care sector. As at May
2020, there needed to be an “extreme” level of risk for CQC to cross the threshold
for inspection. This ensured during the pandemic, that CQC continued to carry out
their regulatory function when there was extreme risk at a service. This was
determined on a case by case basis. CQC'’s inspection priorities remained under
continuous review in line with national priorities, but our monitoring of Stars Social
Support as well as their failure to provide a completed action plan in relation to the
breach of regulation 19, was not assessed as an ‘extreme’ risk in all of the
circumstances. CQC monitored all ASC care providers throughout the pandemic
and has implemented several systems to support remote monitoring of services. A
decision was taken not to inspect the service at this time and the team considered
the providers failure to submit an action plan when reaching this determination.

Section 5, Point 15 — CQC did not take into consideration relevant factors
when risk assessing this care provider at the start of the pandemic leading
to an inappropriate risk profile being established and an exaggerated level
of confidence being placed in the provider to provide safe services to
residents without appropriate monitoring and oversight from the Regulator.

Following receipt of the Regulation 28 report, CQC has reviewed assessments and
monitoring decisions made about the service. At the beginning of the pandemic
CQC monitoring consisted of reviews to intelligence we held about a service,
reviewing received statutory notifications or provider requested information in
surveys. We also reviewed information or concerns received from stakeholders or
the general public. As mentioned in our response under Point 14, our monitoring
of Stars Social Support did not suggest urgent or emergent risk, which would
necessitate a different regulatory approach, such as inspecting sooner, or
enhanced monitoring.

CQC’s approach to monitoring services at the beginning of the pandemic in lieu of
changes to routine inspections was reviewed in December 2020 and CQC
implemented a monitoring system to improve the approach that had been taken
up until that date. This system analyses intelligence we hold about services and

generates a prioritisation score to support operational colleagues to prioritise
services most at risk. This system is used in conjunction with more ‘traditional’
monitoring activities described in the first paragraph of Point 15. This system
continues to inform our regulatory approach to Stars Social Support.

In relation to observations that CQC had an exaggerated level of confidence in the
provider to provide safe services to residents without appropriate monitoring or
oversight. CQC did monitor the service during the pandemic. After the 12 and 13
February 2019 inspection, a management review meeting took place to assess the
seriousness of the breaches identified, risks to people, as well as the provider's
capabilities to improve the service. This management review meeting concluded
that it was appropriate and proportionate to give the Stars Social Support the
opportunity to address concerns identified at inspection. The assessment was
evidence based, robust and balanced. Assessing a care provider's capability to
improve or operate a service safely is a key factor in all CQC’s decision-making
where a breach of regulation is identified. Where appropriate, if the provider can
improve the service on their own and the risks to people who use services are not
immediate, we will generally work with them to improve standards rather than
taking enforcement action. We will intervene if there is evidence that people may
be exposed to the risk of harm, there is serious risk to a person’s life, health or
wellbeing, or providers are repeatedly or seriously failing to comply with their legal
obligations.

Section 5, Point 16 — The report from the August 2020 inspection was
inaccurate and misleading and may have caused service users to be added
to his service where that ought not to be the case. The report published in
October 2020 refers to their being no evidence of harm however there is a
woeful lack of detail about the context of this within the report. CQC should
review this particular report for this provider and also reconsider the way in
which reports are written to ensure that they are no misleading and therefore
dangerous. This includes either omitting from the report any comment about
harm where there is clearly a context and evidence of harm to service users
previously, which is open and live, but which does not form part of the
inspection or very clear confirmation in the report that there has been
evidence of harm which not form part of the specific inspection report.

Stars Social Support has been under voluntary admissions embargo since April
2018 and remains under embargo. Therefore, there is no risk this report may have
caused service users to be placed at the service.

We have reviewed all Stars Social Support inspection reports since April 2018 to
present and found the information contained in CQC reports is accurate and
adheres to CQC guidance available at the time the reports were written. In January
2019 after a period of consultation, the style of CQC reports were reviewed to
become shorter, clearer and easier to understand. The comment in the report that
there was no evidence of harm refers to the period of time since we last inspected

the service (in February 2019) to the inspection date (referenced in the August
2020 report), and in that period we found no evidence of harm. It is recognised that
it doesn’t detail the service’s entire history and does not detail that a service user
had died. However, as the criminal investigation was ongoing at that time, this
inspection did not examine the circumstances of this incident. Had the report
examined the circumstances of the incident it may have prejudiced future
proceedings or caused unfair reputational harm towards the care provider. The
February 2019 inspection report referenced the specific incident and stated in the
summary section, ‘The inspection was prompted in part by notification of an
incident following which a person using the service died. This incident is subject to
a criminal investigation and as a result this inspection did not examine the
circumstances of the incident.’ At that time CQC guidance in relation to report
writing, did not require CQC inspection reports to reference the specific incident
in future reports, only in the report where the incident prompted the inspection.
This remains CQC’s guidance on reporting on specific incidents. This regulation
28 report will be referred to the CQC policy team to consider whether the guidance
needs to be reviewed.

Section 5, Point 17 - Where CQC are required to decide whether evidence
ought to be used for the basis of an inspection or regulatory action, they
ought to ensure there is a consistent approach to this including
consideration of policies and standard operating procedures. This should be
approached on the basis of safeguarding the majority of remaining service
users from harm being the priority even where that means prosecutions for
breaches of regulations may be compromised.

CQC’'s main objective in performing its functions is to protect and promote the
health, safety and welfare of people who use health and social care services. When
CQC are made aware of concerns at a service, the priority will be to ensure that
current service users are safe, and then consideration will be given to whether a
prosecutable offence has occurred. The inspection report details the current
findings at a service, specifically whether a provider is meeting the regulatory
requirements required to be a registered provider. Civil enforcement, (for example
removing a location or cancelling a provider's registration) will be taken if there is
evidence that people may be exposed to the risk of harm or there is serious risk to
a person’s life, health or wellbeing. Criminal enforcement action will be considered
in relation to the specific incident, namely whether there was a registered person
failure to provide safe care and treatment which resulted in avoidable harm to a
service user or a service user being exposed to a significant risk of such harm
occurring. In the matter of Anthony Wilkinson and Stars Social Support, there was
no observed difficulties deciding whether evidence ought to be used for the basis
of an inspection or regulatory action. CQC methodology is clear that these
processes should be conducted separately. There had been no observed delays
inspecting Stars Social Support after the specific incident, to ensure people who
used the service were safeguarded from unsafe care through CQC’s regulatory
model. Whilst evidence from the specific incident was not directly used to inform

inspection judgements, it was still used to help us plan inspections in a manner
that focussed on known risks or potential areas of concern, to robustly assure
ourselves that similar incidents, would not be repeated.

Section 6, Point 8 — Care Quality Commission should urgently review the
report related to this provider from October 2020 and correct any errors or
misleading statements within it.

CQC has reviewed the report (publication date 29 October 2020) in respect of the
inspection completed on 27 August 2020 and 3 September 2020. The report was
accurate at the time of publication and followed the house reporting style. Although
it did not detail the specific incident in relation to Anthony Wilkinson, it had been
referenced in the previous inspection report. It would not be appropriate to make
changes to the October 2020 report retrospectively because it remains CQC’'s
guidance to not report on specific incidents, unless the specific incident prompted
the inspection, which in this inspection it did not.

This regulation 28 report has been referred to CQC’s policy team to consider the
guidance in relation to report writing.

Section 6, Point 9 — Care Quality Commission should review its processes
where their regulatory functions collide with criminal investigations to
ensure that timely regulatory oversight and action is taken notwithstanding,
HSE or indeed CQC prosecution activity.

When CQC are made aware of incident such as the circumstances of the death of
Anthony Wilkinson, the CQC applies Specific Incidents Guidance. The initial
assessment is framed around two questions and will generate two separate
workstreams, and those workstreams can run concurrently.

The first question (Q1) in Specific Incidents Guidance for inspectors generally
serves the first purpose of CQC Enforcement Policy to protect service users from
harm and the risk of harm, and to ensure they receive health and social care
services of an appropriate standard. The actions generated will be the priority. The
workstream could be to carry out an inspection where appropriate to consider
ongoing risk in answer to Question 1. In the matter of Stars Social Support, the
assessment of Q1 precipitated an action to inspect the service in May 2018, shortly
after Anthony Wilkinson’s death. Provider assurances and Stakeholder actions
taken or planned at that time fed into CQC’s assessment of Q1.

The second question (Q2) in Specific Incidents Guidance for inspectors
determines whether to progress to formal criminal investigation of the historic
specific incident of avoidable harm under Reg 22(2), Health and Social Care Act
2008 (Regulated Activities) Regulations 2014. The second active work stream
may, in answering Question 2, be to carry out a formal criminal investigation to
investigate historical non-compliance relevant to that historic specific incident. In

the matter of Anthony Wilkinson, a criminal investigation was completed, and the
outcome was no further action.

Section 6, Point 10 — Care Quality Commission should review the
presentation of its report to ensure that where statements such as ‘we found
no evidence of harm to service users’ are placed in the context of the
inspection. For example, statements should be read as ‘This service has 90
service users. We inspected 9 records as part of our inspection, and we
validated these records against the care provided to those service users. We
checked the records held by the Head Office and did not confirm that these
were replicated in the service users home address. Of those records we did
not find any evidence which would support breaches of Regulations relating
to the delivery of safe care’. The organisational context of an inspection is
as important as the individual outcomes found on the day of inspection;
indeed, it is the context which sets the inspection intervals.

We have addressed some of your comments in our earlier response (Section 5,
Point 16). As stated in our earlier response we have reviewed the report in
question, and we are satisfied that the content is accurate and complies with
CQC's house style.

Historically CQC did have lengthier reports, which similarly conveyed the level of
detail as explained in your example. However, following a lengthy review/
consultation period with commissioners/providers/and the general public, about
what information we should include in CQC reports, it highlighted a need to change
our house style. The results of this review showed some reports were inconsistent
in content from service to service, were difficult to understand, and did not
effectively support people or commissioners to make an informed choice about
care services. Another common theme was that many people who accessed our
reports on our website did not read the inspection reports beyond the first page.
The shorter report guidance was implemented in January 2019 to address
comments from our main audience, commissioners and the general public. In the
guidance it directs inspectors to write ‘judgment statements’ instead of providing
detail about context to support this statement, which is not always necessary or
appropriate. The shorter report format includes important contextual information
about the service in the summary and background sections. For example, it
includes details like when we last inspected, records we looked at, the number of
people we spoke to, previous ratings and (publishable) enforcement actions.

This Regulation 28 report has been referred to CQC’s policy team to review this
further.

Section 6, Point 11 — Care Quality Commission should review the way in
which it treats evidence which relates to inspection standards and breaches

of Regulations (including criminal offences) where that evidence relates to
the same actions.

Evidence gathered during the course of an inspection will feed into inspection
reports and where relevant civil enforcement action. The information may lead
CQC to carry out a criminal investigation, but the evidence gathered during a
criminal investigation will not be detailed in an inspection report. A report must
provide an accurate reflection of what is happening at a service, but that does not
require the report to detail the criminal investigation.

As your comment concerns CQC policy around how we treat evidence, the relevant
team in the Commission will review this further.

Thank you for your assistance bringing certain concerns and actions to CQC’s
attention. CQC will continue to monitor, inspect and regulate Stars Social Support
in a manner which places service user safety at the forefront of what we do.

Yours sincerely

\\ael

Head of Inspection

INHS)

South West

Yorkshire Partnership
NHS Foundation Trust

8.6.2021

Director of Nursing & Quality &
Deputy CEO

Trust Headquarters

Fieldhead

Wakefield

WF1 3SP

Regulation 28 Report Response — Anthony Wilkinson — Inquest Concluded 26 March
2021

Dear Ma’am,

In response to the Regulation 28 the Trust wish to respond with the following information.

1. The guidance sheets which have been produced are still not clear enough and will
lead to confusion including around the consistency description and a list of foods
which can be modified or should be avoided.

As you will be aware ne Speech and Language Therapist Lead for Learning
Disability Services gave evidence in respect of the Level 6 food consistency advice sheets
provided by the Learning Disability Soeech and Language Therapy (SALT) Service. As part of
both her written and oral evidence, HE agreed that these advice sheets could, subject to
review via the appropriate governance procedures, be updated to address the concerns you
raised during the course of the inquest proceedings.

On 18! May 2021, | with other Learning Disability Speech and Language
Therapists, met and reviewed the services level 6 food consistency advice sheets in their
Dysphagia Speech and Language Therapy Learning Disability meeting. As a result of this review,
the advice sheets were amended in response to your concerns as follows:

1. Removal of the picture anomalies, such as the removal of the image depicting cut up melon,
which was in-fact a food to be ‘avoided’.

2. Amendment of statements and wording to remove potential ambiguity. For example:
e Old wording:

With all of us in mind.

UNIVERSITY OF LEEDS

Associated teaching trust status oc

2008 =

To protect the environment and save money this letter is printed on recycled and unbleached paper.

NHS

South West

Yorkshire Partnership
NHS Foundation Trust

o “These foods can be especially hard to chew or swallow so need to be avoided
or specially prepared so that they meet the consistency description.”
e New wording:
o “These foods are considered high risk for people with chewing and swallowing
difficulties.
o Forsafety, AVOID these food textures that pose a choking risk for people on a
soft and bite sized consistency
o Some foods can be modified to meet the consistency recommendation.
o Any food that cannot be suitably modified MUST BE AVOIDED.”

3. Amendment of the ‘high risk’ food information list to contain two distinct columns:
e Column 1: ‘Food types and examples of food to AVOID’; contains food types and
examples of foods that must be avoided,

e Column 2: ‘Modified Options’; this is left blank in order to enable a personalised and
person-centred approach to identify foods that can be modified for the service user.

| have enclosed a copy of the Learning Disability SALT Services updated level 6 food
consistency advice sheet to this letter. | can confirm this sheet was implemented within the
service on 2™ June 2021.

The Trust remains committed to learning from incidents and we will continue to apply a quality
improvement approach to ensure required changes are embedded within our clinical services.

| do hope the above information is of assistance and answers the concerns raised within your
Regulation 28 report following the sad death of Anthony Wilkinson.

Yours faithfully,

4, / f I 4

Director of Nursing & Quality / Deputy CEO
South West Yorkshire Partnership NHS Foundation Trust

Speech and NHS}

South West

la ng uage thera py Yorkshire Partnership

NHS Foundation Trust

Swallowing advice:

Soft and Bite Sized

Why do I need soft and bite sized food?

e You have some difficulty chewing and swallowing food.

e You are not able to ‘bite off’ pieces of food safely but are able to chew bite-sized
pieces down into little pieces that are safe to swallow.

e You are at risk of choking

|
| Vv Food is soft, tender and moist throughout.
Y_ Chewing is required before swallowing.
Easy to chew

sid | Food can be eaten with a fork or spoon.

| 3w | Food can be mashed or broken down easily by
pressing with a fork or spoon.

Easy to break up with a fork |

er
—<—

| Sometimes needs a sauce

Y Thick sauces may be required.

Bite-sized for adults |
1.5cm

ae /

Bite sized

| 3% No separate liquid.
| 9 No hard pieces of food.

No high risk food.

| Food should be bite sized and no bigger than
1.5cm x 1.5cm (about the size of a thumb nail).

With alll of us in mind.

Based on IDDSI Framework reviewed May 2021. For further information please contact speech and language therapy.

v Pressure from a spoon/fork held on its Y Food does not return to its original
side can be used to ‘cut’ or break the shape when the spoon/fork is
food into small pieces. removed.

When a piece 1.5cm x 1.5cm is pressed
with a fork gently, it squashes.

This YouTube link demonstrates the fork
pressure test:
https:/Awww.voutube.com/

watch?v=1wfODug5BmQ

Examples of soft and bite sized prepared meals.

Based on IDDSI Framework reviewed May 2021. For further information please contact speech and language therapy.

Meat and Poultry
Y Cooked tender meat no bigger than 1.5cm x 1.5cm.
v Remove all skin, bones and gristle.

v If texture cannot be served soft and tender, serve minced and ina
thick cohesive sauce.

v Casserole/curry liquid should be thick (as per Speech and Language
therapist's recommendations around fluid).

Fish

Y_ Remove skin and bones.

Y Cooked, soft fish, broken into pieces no larger than 1.5cm x 1.5cm.
% Avoid hard/crispy batter.

Vegetables, Potatoes

Y Steamed or boiled vegetables with a final cooked size of 1.5cm x
1.5cm.

Y Vegetables should be well cooked until soft.
% = Avoid stir fried vegetables.
% Avoid stringy vegetables e.g. runner beans, asparagus, kale.

Fruit
Y Drain excess juice. Remove pips, fibrous parts and skin.
v Pieces should be soft and no bigger than 1.5cm x 1.5cm.

| ¥_ Please refer to high risk food list

Cereal
Y_ Should be smooth and fully softened.
v_ Add enough milk to avoid a sticky consistency.
v_ Drain excess fluid before serving.
% Avoid cereals that contain dried fruit and nuts/flaked nuts.

|
4 Rice
gt ® v_ Needs a thick sauce to moisten and hold the rice together.

¥_ Drain or thicken any excess fluid before serving.
% Not sticky or glutinous.
% Does not separate into individual grains when cooked and served.

Bread

3% No sandwiches or bread product of any kind, including pizza, wraps,
pitta, crumpets etc,

3% No bread unless assessed as suitable by a speech and language
therapist.

Based on IDDSI Framework reviewed May 2021. For further information please contact speech and language therapy.

HIGH RISK FOODS

These foods are considered high risk for people with chewing and swallowing
difficulties.
For safety, AVOID these food textures that pose a choking risk for people on a
soft and bite sized consistency.
Some foods can be modified to meet the consistency recommendation.

e Any food that can not be suitably modified MUST BE AVOIDED.

Food types and examples of
food to AVOID

fas Dry foods

> 4 Crackers, cake, bread...

Modified options

Crumbly Foods

> 4 Biscuits, pie crust, crumbly dry
cakes...

Hard foods
% Boiled sweets, nuts...

Tough or chewy foods

x Steak, bacon, harder vegetables,
sweets, cheese...

Crispy or crunchy foods

x Crisps, flaky pastry, raw carrot/
apple, popcorn...

Stringy or fibrous foods

% Pineapple, celery, green beans,
rhubarb...

Based on IDDSI Framework reviewed May 2021. For further information please contact speech and language therapy.

Pips, seeds, pith/inside skins,
outer shells

% Peas, grapes, fruit skins or husks
like sweetcorn...

Round or long shaped foods

% Sausages, grapes, sweets. Hard
chunks, like pieces of apple...

Juicy food where the juice
separates off in the mouth

% Melon...

Floppy foods

% Lettuce, thinly sliced cucumber,
spinach...

Sticky foods

3% Some cheese, marshmallows,
over cooked porridge...

Mixing solid food with liquid

% Hard cereal, fruit salad with juice
and soups with food pieces...

If you have any concerns regarding your diet or you need to follow a special diet due
to a medical condition, please speak to your GP who may refer you to a dietitian.

Based on IDDSI Framework reviewed May 2021. For further information please contact speech and language therapy.

Meal suggestions

Breakfast

e Ready Brek

e Weetabix (ensure it is well soaked in milk but with no excess fluid)
e = Thick yoghurt

e Stewed fruit or banana and yoghurt

e Scrambled egg/ soft boiled egg/ poached egg

Smoked haddock with plenty of butter.

Main meals
Pasta with cheese or tomato sauce, for example macaroni, ravioli or Bolognese

e Well-cooked vegetable/ mince curry with plenty of sauce

e Shepherd's pie/ cottage pie

e Poached fish in lots of sauce

e¢ Well cooked broccoli or cauliflower with cheese sauce

e = Chilli and rice with a thick smooth sauce

e Thick soups (add potato to thicken to correct consistency)

e¢ Corned beef hash

e Fish pie (mashed potato on top) — remove all bones and no sweetcorn or peas

e Stew/casserole: all types of cooked meat and poultry (chicken, turkey, beef, corned beef, lamb,
liver, pork) which have been slow cooked and are very tender and served with thick gravy or a
savoury sauce.

Vegetables _

e Mashed potatoes (add cheese, butter, cream, gravy, cream cheese or soft cheese)

e Soft boiled potatoes (without the skin)

e Jacket potatoes (without the skin)

e

Well-cooked / soft vegetable, for example carrots, swede, butternut squash, broccoli, parsnips,
cauliflower

¢ Broccoli or cauliflower cheese

e¢ Soft avocado.

Fruit / desserts

Stewed fruit (no skins)

Soft, ripe fruits, for example banana, peach, mango, berries (no skins)
Cake and custard

Créme caramel

Blancmange

Angel delight

Mousse

Custard

Thick and creamy yoghurts, fromage frais

Ice cream and jelly (not suitable for people who need thickened fluids).

Snacks

Smooth paté that is not sticky or dry

Tinned spaghetti

Egg mayonnaise

Tinned tuna or salmon (mash with salad cream, mayonnaise or cheese sauce)
Hummus

Avocado.

These are examples of meals but not exclusive options for this diet.

Based on IDDSI Framework reviewed May 2021. For further information please contact speech and language therapy.

RESPONSE OF STARS SOCIAL SUPPORT LIMITED

A decision has been taken by the Registered Manager and Director of Stars Social
Support Limited for the organisation to cease to continue. The Registered Manager
and Director at Stars Social Support Limited has contacted the Local Authority and
the Care Quality Commission to notify them that Stars Social Support Limited will
cease to continue.

The Registered Manager and Director at Stars Social Support Limited is now liaising
with the Local Authority and the Care Quality Commission to ensure provisions are
put in place for the transfer of the existing service users.

In view of the above decision, a detailed response in relation to the corrective actions
indicated in the above report is not be provided.

ee

Registered Manager and Director of Stars Social Support Limited

{ \~ 4

Date of Response BIN

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