Prevention of Future Deaths reports · 2022

Robert Howell

Regulation 28 report to prevent future deaths, reference 2022-0294, written 26 Sep 2022. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.

Date of report26 Sep 2022
Reference2022-0294
DeceasedRobert Howell
CoronerLorraine Harris
Coroner areaEast Riding and Hull
CategoryCare Home Health related deaths
Sourcejudiciary.uk record · original PDF
Responses published1

The report

Text extracted from the PDF text layer. Reproduced verbatim, including the scan's own layout.

REGULATION 28:  REPORT TO PREVENT FUTURE DEATHS (1) 

NOTE: This form is to be used after an inquest. 

REGULATION 28 REPORT TO PREVENT FUTURE DEATHS 

THIS REPORT IS BEING SENT TO: 

Residential Manager, Elm Tree Court Care Home, 
344, Preston Road, Hull, HU9 5HH 

And their overseeing management: 
HICA Group, Anchor Court, Francis Street, Freetown Way, Hull, HU2 8DT. 

1 

CORONER 

Lorraine Harris, Area Coroner, 
East Riding of Yorkshire and City of Kingston Upon Hull. 

2 

CORONER’S LEGAL POWERS 

I make this report under paragraph 7, Schedule 5, of the Coroners and Justice 
Act 2009 and Regulations 28 and 29 of the Coroners (Investigations) Regulations 
2013. 

3 

INVESTIGATION and INQUEST 

On 25th April 2022 I commenced an investigation into the death of Robert 
Norman HOWELL, age 91 years. The investigation concluded at the end of the 
inquest on 23rd September 2022. The conclusion of the inquest was: 

Narrative:  Robert Norman Howell “Bob”, aged 91 years, was susceptible to 
falling.  On 12th April 2022 in his room at Elm Tree Court care home Mr Howell 
fell backwards and banged his head sustaining a subdural haematoma.  He was 
conveyed to Hull Royal Infirmary where he died on 20th April 2022. 

Cause of Death: 
1a 
2 
Stenosis 

Subdural Haematoma 
Atrial Fibrillation, Severe left ventricular systolic dysfunction and Aortic 

4 

CIRCUMSTANCES OF THE DEATH 

Mr Howell have a history of falls and did not have capacity.  In February 2022 he 
went to reside at Elm Tree Court care home.  He had the relevant pre-
assessment before admissions and had care plans devised when in the home. 
He suffered falls on 10th and 11th April 2022.  Care staff for the night of 11-12th 
April 2022 were made aware of the fact he had fallen once on 11th, but not his 

1 

 history of frequent falls. 
In the early hours of the 12th April 2022 his sensor mat activated, indicating that 
he had got out of bed.  The carer attended and found him standing by his bed, 
he was naked.  The carer was unsure why she did not firstly ask him to sit on the 
bed but she spoke to him and moved to his wardrobe to obtain clothing for him.  
As she did so he stumbled backwards and struck his head.  An ambulance was 
called.  He died in hospital from a subdural haematoma on 20th April 2022. 

5 

CORONER’S CONCERNS 

During the course of the inquest the evidence revealed matters giving rise to concern. In 
my opinion there is a risk that future deaths could occur unless action is taken. In the 
circumstances it is my statutory duty to report to you. 

The MATTERS OF CONCERN are as follows.  –  

(1)  Team Leaders held handovers between themselves, it was then up to 
the individual Team Leader to decide what to pass on to the staff 
responsible for caring.  It became apparent during evidence that often 
vital caring and risk needs were not always cascaded to the staff 
interacting with the residents.  As such vital information to those 
responsible for providing care was often not provided.  

(2)  Care plans were held in the office.  Staff were not instructed to read the 
care plans.  It was left to an individual carer to decide if they wished to 
seek out the care plan.  No time was set aside for staff to familiarise 
themselves with the care plan or individual needs and risks of the 
residents.  Vital information could therefore be missed by those 
responsible for providing care. 

(3)  Evidence showed a lack of understanding about the falls policies in 

place. 

(4)  It was acknowledged that the home did have procedures introduced 

since Mr Howell’s death however it became evident that there was still a 
breakdown in communication and vital information was not being 
shared.  There appeared to be a lacuna in what information should be 
passed to all staff and how confirmation of understanding was checked. 

6 

ACTION SHOULD BE TAKEN 

In my opinion action should be taken to prevent future deaths and I believe 
your organisation have the power to take such action.  

7 

YOUR RESPONSE 

You are under a duty to respond to this report within 56 days of the date of this 
report, namely by 16th November 2022. I, the coroner, may extend the period. 

Your response must contain details of action taken or proposed to be taken, 

2 

 
 
 
 
 
 
 
 
 
 
 
 
 
 setting out the timetable for action. Otherwise you must explain why no action 
is proposed. 

8 

COPIES and PUBLICATION 

I have sent a copy of my report to the Chief Coroner and to the following Interested 
Persons: 
• 

 (sister) as a representative of the family 

I am also under a duty to send a copy of your response to the Chief Coroner and all 
interested persons who in my opinion should receive it.   

I may also send a copy of your response to any other person who I believe may find it 
useful or of interest.  

The Chief Coroner may publish either or both in a complete or redacted or summary 
form. He may send a copy of this report to any person who he believes may find it useful 
or of interest.  

You may make representations to me, the coroner, at the time of your response, about 
the release or the publication of your response. 

9 

[DATE]                                              [SIGNED BY CORONER] 

26th September 2022                                  Lorraine Harris 

3

Responses

1 response published against this report on judiciary.uk. A response is a body's written reply to the coroner's concerns; publication is at the discretion of the Chief Coroner's office, so an absent response does not mean nobody replied.

Response from Hica Group (PDF)
hica 

supporting better lives 

Heather Joy 
Director of Operations 
HICA 
Hesslewood Country Park Office 
Hessle 
HUB 0LH 

1 Nov  ,,

c.'fJ22 

The Coroners Courts & Office 
The Guildhall 
Alfred Gelder Street 
Kingston  upon Hull 
HUl 2AA 

11th  November 2022. 

Report to Prevent Future Deaths 

Dear sirs 

Thank you for the correspondence and report to prevent future deaths in relation to the tragic 
death  of Mr.  Robert  Norman  Howell, who had  been  residing  at Elm  Tree  Court Care  Home, 
Hull.  Humberside  Independent  Care  Association  (HICA)  would  like  to  respond  with  the 
comments and  actions detailed below. 

The  MATTERS  OF  CONCERN  are  as follows. 

(1)  Team  Leaders held handovers between themselves, it was then up to the individual 

Team  Leader to decide what to pass on to the staff responsible for caring.  It became 
apparent during evidence that often vital caring and  risk needs were not always 
cascaded to the staff interacting with the residents.  As  such  vital information to 
those responsible for providing care was often not provided. 

HICA  Response. 
HICA  has  always had  a process in  place that formal handovers occur between shifts 
for staff. Staff should attend the handover meeting, but we did not have a system  in 
place to record attendance at handovers. We have now introduced a standard 
handover template and  attendance sheet into all services.  In  addition to this, we 
have introduced electronic care planning, whereby staff have access to up to date 
care  plans,  records,  and  risk assessments for each  resident,  at the point of care 
delivery. 

making a difference 

t. 01482 581000  w.  www.hica-uk.com 

Humberside Independent Care Association  Limited (Charitable Status) 

Anchor Court, Francis  Street,  Freetown  Way,  Hull  HU2 SDT 

Company Registered  Number IP27662R 

 (2)  Care  plans were held in the office.  Staff were not instructed to read the care  plans. 

It was left to an  individual carer to decide if they wished to seek out the care  plan. 
No time was  set aside for staff to familiarise themselves with the care plan or 
individual needs and  risks of the residents.  Vital information could therefore be 
missed  by those responsible for providing care. 

HICA  Response 
It has  always been  imperative for staff to read care  plans of residents within services, 
and this has  always formed part of induction training when staff commence 
induction into the workplace. We  have now introduced electronic care planning, and 
staff hold devices which contain care plans on them during care, which means staff 
have information at the point of care delivery, which  is contemporaneous. This is 
also supported  by a change in the handover process,  and  the introduction of 'Flash' 
meetings in  all services, which occur daily to provide any further updates to staff in 
regard to care support of residents during the shift. 

(3)  Evidence showed a lack of understanding about the falls  policies in  place. 

HICA Response 
HICA  has  a falls  policy in  place, which is  cognisant of information contained within 
NICE  Clinical  Guideline CG  161(Reviewed 2019)- Falls  in  older people: assessing risk 
and  prevention. Our falls policy has been further reviewed and we are  in the process 
of rolling out the use of the iSTUMBLE platform, which will be available on all 
handheld devices within our services. The app provides information to support staff 
on procedures to undertake when a resident has  a fall. This will work in  partnership 
with the falls policy and will is  available at the point of care for staff to utilise. 
Alongside the falls diaries that are currently in  place  in services, we are also 
introducing weekly service falls meetings, which will review any falls incidents and 
ensure that risk assessments, and  referrals if required have been  complete and 
actioned. The  addition of iSTUMBLE and the introduction of weekly falls  meetings 
has been  added to the reviewed falls policy, which will be  rolled out to all services 
throughout November 2022. 

(4)  It was acknowledged that the home did have procedures introduced since Mr 
Howell's death  however it became evident that there was still a breakdown in 
communication and vital information was  not being shared.  There appeared to be a 
lacuna in what information should be  passed to all staff and  how confirmation of 
understanding was  checked. 

HICA Response 

We  have reviewed the concern noted in relation to communication and  information 
sharing. The measures discussed  in the previous three points have been introduced 
to aid  the sharing of information and  facilitate better communication. This will be 
supported by the continued use of staff supervisions. 

 '1/!it. Sincerely 

Director of Operations,  HICA

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