Dorothy Macdonald

Activecare Ltd
T/A Westwood Hall Nursing Home,
Brimstage Road, Brimstage, Wirral CH63 6HFT 0151 342 2150

springcare.org.uk

David Lewis
Assistant Coroner for Liverpool and The Wirral

By e-mail only

Dear Mr Lewis,

30 January 2026

Inquest Touching the Death of Dorothy Ann Macdonald

Thank you for your Regulation 28 report of 17 December 2025 following the Inquest into
the death of Dorothy Ann Macdonald (hereinafter “Mrs Macdonald”). I am responding on
behalf of both Activecare Ltd t/a Westwood Hall Nursing Home (hereinafter “the Home”)
and the overall care provider, Springcare Limited.

I know that you will share a copy of this response with Mrs Macdonald’s family, and I
would like to take this opportunity to express my condolences for their loss.

Concerns Raised

In your Regulation 28 report you raised the following concerns with regards to the
Home:

  That staff had incorrectly assessed and documented Mrs Macdonald’s risk of
falling as being at ‘low’ and later ‘medium’ likelihood, and that they had also
underestimated the likely impact of the harm resulting in an understated overall
risk score;

  That falls risk training was not effective and/or being adopted properly by those

staff members responsible for undertaking falls risk assessments; and

  That there had been a failure to refer to the Falls Team in accordance with the

Falls Policy

In light of the above concerns you have sought clarification as to the steps which are
being taken to ensure that all relevant staff have received, understood and consistently
act upon suitable and sufficient training in the assessment of falls risk. You have further
asked for clarification as to how the Home will satisfy itself:

Registered Office Address Nicholson House, Shakespeare way, England, SY13 1LJ

Company No. 03043187

 a)  that all relevant staff have received, understood and consistently act upon

suitable and sufficient education about the circumstances in which, and how, a
referral to the falls team should be made; and

b)  that the service is sufficiently responsive and effective in responding to requests

for its specialist input.

Response

At the outset I would like to reassure you that we have reflected seriously upon the
contents of your Report, both within the Home and across the broader service, and that
we welcome the opportunity to identify learnings, as well the opportunity to both improve
the quality of our care provision and strengthen the existing policies and procedures
where appropriate.

Assessment and Documentation of Falls Risk

I acknowledge that Mrs Macdonald was initially assessed by the deputy manager at the
Home as being at low risk of falls. This assessment was made on the basis she did not
have a falls history, and it was understood and anticipated that she would not be very
independently mobile. Whilst we do not consider that it was unreasonable for the deputy
manager to initially assess the risk as low on the limited information available at that
time, I accept that there may be a limited range of opinion in this regard which could
include Mrs Macdonald being deemed at a higher level of risk in view of her frailty,
dementia and potential for a serious adverse outcome in the event of a fall.

Despite the initial assessment of the falls risk as low, Mrs Macdonald was placed on a
system of hourly checks from the outset in order to monitor her. Within days of her
arrival at Westwood Hall and prior to any falls occurring, it was quickly ascertained that
Mrs Macdonald was in fact capable of mobilising independently and was doing so. Staff
accordingly identified that her overall falls risk was correspondingly significantly higher
than first thought. Consequently, the frequency of the safety checks was immediately
increased to every 30 minutes, and the use of a bed/chair sensor pad was
implemented.

These risk prevention measures, which were appropriate for someone with a high to
very high risk of falls, were clearly documented in the care notes ensuring that all staff
caring for Mrs Macdonald were fully aware of the increased and significant risk and the
mitigation measures in place. The relevant risk assessments and care plans for Mrs
Macdonald were reviewed and updated to reflect these additional enhanced measures.
However, it is acknowledged and accepted that, due to an administrative oversight, staff
omitted to also amend the numerical risk rating on the electronic record system.

After each of Mrs Macdonald’s subsequent falls staff reviewed the measures already in
place to determine whether any additional steps could be taken. Mrs Macdonald was

Registered Office Address Nicholson House, Shakespeare Way, England, SY13 1LJ

Company No. 03043187

 respectively: i) moved to a room affording increased visibility to staff, ii) provided with a
raised toilet seat to assist her in getting on and off the toilet, and iii) had her recliner
chair swapped for an ordinary armchair at the family’s request. These measures were
also documented and recorded in the care plans and notes.

I would therefore respectfully contend that Mrs Macdonald’s risk of falls was
appropriately assessed, monitored, reviewed and identified as high prior to any falls
occurring. I do accept that the numerical overall risk rating was not correctly updated on
the electronic record system to reflect the identified increased risk, however, this
omission had no practical impact on the care which was actually provided to Mrs
Macdonald or the risk reduction measures which were put in place. These were
comprehensive and entirely appropriate in all the circumstances and I note your findings
in that regard.

I would respectfully submit that this was a discreet error of documentation, not one of
risk assessment or care provision, and is not reflective of general failings or
inadequacies in falls risk assessment at Westwood Hall. I am furthermore confident that
all of the residents at Westwood Hall have had their falls risks assessed and correctly
identified, that they all have appropriate falls prevention measures in place, and that
these are clearly documented in the care records.

To ensure this is the case we have undertaken a review of all residents’ care plans and
documented risk scores to ensure that these numbers correctly reflect the identified falls
risks. We have also provided refresher training to the relevant staff to ensure that these
risk scores are appropriately adjusted on the system when risk assessments and care
plans are reviewed and updated. This has been documented as a supervision.

Training

I can confirm that the staff who are responsible for assessing and reviewing residents’
falls risk at Westwood Hall have been sufficiently and suitably trained. They understand
and consistently act on this training, in conjunction with their clinical judgement and
experience, so that a resident’s risk of falls is assessed, monitored and reviewed with
increased risks promptly identified and responded to. I enclose key training documents
for your reference.

I would furthermore like to reassure you that Springcare undertake monthly reviews and
audits of residents’ care across its whole provision in order to identify any relevant
trends, patterns or areas where the provision can be bolstered and enhanced.

Referrals to the Falls Team

Springcare are currently reviewing their Falls Policy to determine whether further, more
specific guidance can be included regarding when and in what circumstances a referral
to the Falls Team should be made.

Registered Office Address Nicholson House, Shakespeare Way, England, SY13 1LJ

Company No. 03043187

 It is necessary to consider that residents’ frequency of and propensity for falls can vary
extensively based on their individual situations and capabilities, and that a single set of
guidelines or prescribed course of action may therefore not be appropriate in every
circumstance. It is also necessary to take into account the fact that not all areas offer a
Falls Service to which referrals can be made. Efforts are, however, being made to
identify a broad-brush approach which managers can adopt, in conjunction with their
own clinical judgement and/or advice from GPs or other external medical professionals.

In the interim and in response to the concerns raised, Westwood Hall has adopted the
approach of referring any resident who has fallen, regardless of the circumstances, to
the Falls Team. Staff have been made aware of this new approach.

Neither Westwood Hall nor Springcare is in a position to ensure that a Falls Service, a
third-party service, is sufficiently and effectively responding to requests for its specialist
input. Westwood Hall are, however, implementing a system whereby any referrals made
to the Falls Team are chased up after 2 and 4 weeks respectively where no response
has been received, and that these chasers are documented in the resident’s care
records.

Thank you again for bringing your concerns to my attention. I trust that this response
provides assurance that appropriate action is being taken to address those concerns.

Yours sincerely,

Operations Manager
Springcare Limited

Registered Office Address Nicholson House, Shakespeare Way, England, SY13 1LJ

Company No. 03043187