Inadequate cell sharing risk assessment for epilepsy and sexual orientation
HMP Pentonville received 2 coroners' reports about this hazard between 16 Jun 2014 and 31 Oct 2017.
They came from 1 coroner. A similar concern was raised again 1 time after the first warning.
No published response from HMP Pentonville was found for the earlier reports.
The story, report by report
Spacing grows with the time between reports.
“The nurse who carried out the first reception screen of Mr [name redacted] did not complete a cell sharing risk assessment (CSRA)”
Original on judiciary.uk ↗ No published response from HMP Pentonville was found for this report.
- 3 years 5 months laterClosely relatedConfidence 0.80 · moderate
“Mr [name redacted] described himself variously as heterosexual and bisexual. The latter was recorded on his cell sharing risk assessment form.”
Original on judiciary.uk ↗ Repeated from the earlier report:cellsharingriskassessment
The most recent report. A response may not be due or published yet.
- All reports to HMP Pentonville
Each row is one judged link between an earlier and a later report. Open a row to read both quotes, found word for word in the originals.
2014 → 2017Vilhelmas Borkertas3 years 5 months after David O'Garro · same coronerClosely relatedConfidence 0.80 · moderate
Closely relatedConfidence 0.80 · moderateBoth reports highlight failures in the proper application of cell sharing risk assessments when assigning cellmates.
David O'Garro · 16 Jun 2014
“The nurse who carried out the first reception screen of Mr [name redacted] did not complete a cell sharing risk assessment (CSRA)”
Original on judiciary.uk ↗ Vilhelmas Borkertas · 31 Oct 2017
“Mr [name redacted] described himself variously as heterosexual and bisexual. The latter was recorded on his cell sharing risk assessment form.”
Original on judiciary.uk ↗
No published response from HMP Pentonville was found for this report.
No published response from HMP Pentonville was found for this report. It is the most recent report, so a response may not be due or published yet.
- Each report's concerns were extracted by Nemotron 3 Nano on Nebius Token Factory, each with a quote copied from the report.
- Concerns from reports to HMP Pentonville at least six months apart were compared by meaning (Qwen3 embeddings) and wording (TF-IDF).
- The closest pairs were judged by Nemotron 3 Super with reasoning on. Only identical or closely related, with confidence of at least 0.70, are shown.
- Every quote was checked by code as an exact substring of the original text. Names of staff and family are redacted, and the deceased are named by report title only.
| Link | Meaning | Wording | Judge | Coroner |
|---|---|---|---|---|
| 2014 → 2017 | 0.69 | 0.31 | Closely related · 0.80 | same |
Judge model: nvidia/nemotron-3-super-120b-a12b. How Nemotron did the work · Full methodology.
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Other chains for HMP Pentonville
This shows that a similar concern was raised again after an earlier report. It does not say why, and it is not a finding about any organisation or person. To report an error, see the corrections route.