Recurance · prevention of future deaths reports
Pre-inquest brief
Inaccurate documentation of deceased patients
The earlier warning
Alex Blake · 29 Jul 2019 · Andrew Harris, London Inner (South)
“During the course of the inquest, the evidence revealed concerns with the implications of the evidence of three witnesses employed by NHS Professionals at times when the deceased was already dead.”
What was promised
Stated action 1 · response to Alex Blake (29 Jul 2019) · stated timescale: none stated
“| have passed your report regarding the two registered nurses to our Fitness to Practise team for further investigation; we have now also received a formal referral from NHS Professionals in respect of these two nurses. The case of the two nurses is now with our screening team and they will use the information we have received from your office and NHS Professionals to consider the matter further.”
What recurred
- 2 Aug 2024 · James Capstick · Nicholas Shaw · Closely related · confidence 0.85 (high)
The clearest link, quoted from both reports:
Earlier · Alex Blake · 29 Jul 2019
“During the course of the inquest, the evidence revealed concerns with the implications of the evidence of three witnesses employed by NHS Professionals at times when the deceased was already dead.”
Later · James Capstick · 2 Aug 2024
“(1) To Westmorland Court. The General Practitioner who came to give evidence said that care had improved since Reg's death but he still had concerns about care given and had to visit regularly every week to check residents -the only one of six homes he covers that requires this level of support. He said it was a struggle to provide good quality care and felt this report would be helpful -as I stated at inquest it is not intended in any way to be punitive but to put focus on areas that may be im”
What happened next
No web check of the stated actions has been published for this chain.